HomeMy Public PortalAbout9173 WOOLLEY ST_Sewer__ 7GA6420 3.55
5APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER---SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDINf, - ?
Ni/M.J. FOX, COUNTY ENGINEER ADDRESS -
CASSATT D. GRIFFIN,SUPT OF BUIi DING LOCALITY rA,e /7 d
NEAREST o'
FOR APPLICANT TO FILL IN CROSS ST. ' c'
LEGAL _ _ —�k —
DESCRIPTION LOT NO. OWNER .�-� j a.` / ,+�e �,1 tid .q r'
BLOCK TRACT 'S c MAIL �-; +'! = ✓
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"+FO. OF SLDGS. _*� -r
_SIZE OF LOT
NOW ON LOT „�.�. CITY t- YTEL. N0.
USE.6 F �-- EE �
� S O NC_5__ '" J-- }�� I DISTR4CTN GROUP -� MAP
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_CONTRACTOR � . $A 'i�. .., I �
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ADDRESS— i�''7 14";;'v'A 4 p° r" ®' _ _-- - CONNECTION DATA_— _ -
TCITY
TEL NO. IY'7 ) p� '- STATION I'EPTH !� tl'Pk'eG'PC
-- [J STATE MANHOLE REFERENCE ,.p> V. LOWER—
REGISfiRATFgN N0. `COUNTY - ---_______._ _ Com• ._._
NO� DESCRIPTION OF WORK - FEE_ L�,.� -
HOUSE SEWER CONNECTING TO s7 TYPE OF CONNECTIO LENGTH FROM `ate e"
PUBLIC EWER � S 3.50 :•,��b -Y. _CiIRR P.L. __ FO_P.Li— d_ --_—.
HOUSE SEWER CONNECTING TO �—__-
PRIVATE DISPOSAL SYSTEM 1.00
��
CONNECT ADDITIONAL BLDG. OR + ,/ P C N(L
r
WORK TO N_OU_5€SrWER_ - 1 00 Cb. In P_NO. 1r ,j jiOJr _JOB_Y_O._.^ .
ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO.
— —
—1 SWER OR DISPOSAL SYSTEDA _ i_60
�1 COtr NFCT AND ABANDON SEWER f
_ ASENPUTOR DISPOSAL SYSTEM
STATE
F ENCROA !McN7
_CNSAPST T NO.
ITF E 4OR
PITS AND/OPDRAIN FLD Z.00 —
,;✓'�—
----
INDUSTRIAL
--�- -- ^--- -- --- WASE APPROVAL --------'----
CESSPOOL-DRYWELL
PECIAL(.GN0f7iON5 ONLY 2.00 CH,9ir- S
OWNER'S — I 1 00 CONNECTION CHARGE FEE,-," -� — --
--1--- ----- -
AUTHORIZATION ^TOTAL FEE � E,.7-1 ��. REIMBURSEMENTS FEE J
F HAVE THIS ➢ADE CONTRACTED VJ E$ TEE HEXIST NAM,W CON- APPROVALS 0;TE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE CESCRIr3Ep EXISTING D'vVELLI;v`G APPROVALS
TO THE PUBLIC SEWER ---__�.-----. _ --'------_—_ .- .---
+"� NEW HOUSE SEWER
SIGNED THIS- [)AY OF .I/it ` �v i�
�,,�+- CONNECT ADDITIONAL
OWNER OR =''4 �"b, - �, f BUILDING OR WORK
OWNERS AGENT— � � _ P��� � r _ I
i:w?`_3'•"^a.4�% ( _�` _ _ SEPTIC TANK,SEEP, Pi7iS?
ADt7RESS�_ —__ AFITIC DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE EAD THIS APPLICATION CESSPOOL[] DRYWELL
. AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR —_
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COU?JT.Y^_,AND STA OF
CALiFCRN[R OR THAT I AM THE LEGAL ,O'N &'`DF THE�` BOVE _AAANDONHQ_USe SEWER
DESCRIBED RESID. NTIA ROPER 'v-'_
�^� '��� .-- BACKFILL SEPTIC TANKS C I
SEEP. PIT(S) CI CESSPOOLS! '
SIGNATURE '� ;. /'�f+t{�'� >" ''
OF PERMITTEE '- Y{
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLEG. INSPECTOR
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