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HomeMy Public PortalAbout9638 WOOLLEY ST_Sewer__ 75463 E-683 Yi-'r"9 APPLICATION FOR PE ■ \MI ■ 1 5�[i-8 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING f ye JOHN A. LAMIBIE,COUNTY ENGINEER _-ADDRESs J CASSATT D.GRIFFIN, SUPT OF BUILDING -LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. D Al J g= { LEGAL r � DESCRIPTION LOT NO. «, ^-y �: OWNER -. .; � -�, fes' J BLOCK TRACT `�'i" I � r - MAIL j -^ Ah f d.J V ""� _ADDRESS ,.. NO. OF BLDGGS. + „iTY SIZE OF LOT__ t..-f~ {jam NOW ON LOT �I a t J/ - �_ / TEL. NO. 1 /. 7 s 0 USE OF BUILDINGS t, i i - DISTRICT NO. GROUP I MAP BK PG + CONTRACTOR ADDRESS t k' —y —-— _ CONNECTION DATA � - STATION t DEPTH CITY- .t%. _.. TEL. NO. .-.._ __UPPER _ ----- MANHOLE REFERENCE x t t�r Y REGISTRATION NOS .f2 COUNTY NO DESCRIPTION O F WORK FEE ---------- - ---- — — -- HOUSE SEWER.CONNECTING TO -� _ - TYPE OF CONNECTIQ LENGTH FROM :rlY- CURB P L.` M L TO P.L. PUBLIC SEWER +a? $3.5_0 ..j I S3.J -- - - g —.�' -- ----- SEPTIC TANK,SEEPAGE PIT OR �� > t— __ I-_PITS AND/OR DRAINFIELD (A ---ttt OVERFLOW SEEPAGE PIT,.DRAINFIELD ----I-�--- — - ---P C NO- - ' J EXTN..,CESSPOOL,DRYWELL,M.4.NHOLE O. tE•I? $2.OiY I CO. IMP.N -- ——-- ------- . t v _. HOUSE SEWER CUNNECTiNG- 70 - I PRIVATE DISPOSAL SYSTEM _ $1.00 TRUNK PERMIT NO, ROAD PERMIT NO. ---- --------------------- --- CONNECTADDI.TIONALBLDG.OR STATEENCROAGHMENT --- - ---- -- - WORK TO HOUSE SEWER Gi $1.00 � I PERMIT NO. j ALTER,REPAIR OR ABA61DON HOUSE INDUSTRIAL j SEWER OR DISPOSAL SYSTEM _@. $I.OU WASTE APPROVAL T--- __ CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 1 00 -- ------- REIIdBURSEMENT FEE AUTHORIZATION TOTAL FEE ro I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- '���'®VALE LATE IINSPECICR SSIG1ATllRE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL 'OWNER OR _ BUILDING OR WORK - OWNERS AGENT ' �, •"r ----- - - --- SEPTIC TANK,SEEP,PIT(S) - _ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL(❑ DPYWELL O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR - PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM j I HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND'JOR ANGELES "�- •_.-- .__._- LICENSED AS REQUIRED BY LOS ANGELES COUNTY STATE OF CALIFORNIA OR THAT 1 ATHE LEGAL OWNER OF DISCONNECT PLUG AND M . THE ABOVE ABANDON HOUSE SEWER-- ---- ---K$ DESCRIBED RES(UENT'IAL PRf3PERTY. � _ BACKFILL SEPTIC TANKS© SIGNATURE --ff SEEP.PITS) ❑ CESSPOOLS 0 OF PERMITTEE "7 d - ---- IOHN A, LAMBIE,C0414TY ENGINEERVALIDATI® ROBERT.A: WOOD,CHIEF PLBG. INSPECTOR CK. M.O. CAH - S