HomeMy Public PortalAbout9639 WOOLLEY ST_Sewer__ , 5�TI.Sa
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcstsnant of County Engineer
County of Las Angeles BUILDING
_ADDRESS---.._.rL
JOHN A. LAMBI�., COUNTY ENGINEER
D CASSATT D. GRIFFIN, SUNT OF BUILDING LOCALITY'
NEAREST
FOR APPLICANT TO. FILL IN CROSS ST.
LEGAL t DESCRIPTION LOT N0. _ OWNER 4. "ar, �' -'�� ,,, .. - •"y _
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I-;-'-- MAIL .. --
BLOCK TRACT
` NO.OF BLDGS. J c -
SIZE OF LOT ,}l NGW ON LOT d �q 9.Fw- CITX;,, p�,, TEL. NO. ® 4C '
USE OF
BUILDINGS DISTRICT NO, 1 -ROUP MAP
CONTRACTOR. B - -
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CONNECTION DATA
ADDRESS 4-"/ *' _ - �*�i s- z - ----- --..- ---------- --- - - --
S y STATION ' j e DEPTH e _
CITY�, E TEL. NO. ------ -.-- -- - -- -
--- -K-- —�_ MANHOLE REFERENCE
UPPER
ZI STATE ----- -— Y"
REGISTRATION NO, '' ;{ ;i ;� _ COUNTY --
NO. DESCRIPTION OF WORK FEE J TYPE OF CONNECTION LENGTH FROM
USES
CONNECTING TO `" I Y. CURB P.L, M.L.TO --
^ CPUBLIG SEWER _ @ $3.50 .� ;;: -- - - -M. - - --
--z ' SEPTIC TANK,SEEPAGE PIT OR �-
PITS AND/OR DRAINFIELD (a'_$3.0.0 -
----I OVERFLOW SEEPAGE PIT,DRAINFIELU --- P. C NO.
EXTN.,CESSPOOL,DRYW_ELL,14FkNHOLE C� $2.00 ! CO. IMP. NO. {=
i HOUSE SEWER CONNECTING TO V - ----�-�- -- - --�- `+. -
PRIVATE DISPOSAL SYSTEM. Ca _$_1.00._1 . ! TRUNK PERMIT NO. ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1.00 j ,_! PERMIT NO.__
-- --- ----- -.-�._ .- 9 _- _
---iALTER,REPAIR OR ABANDON HORSE I INDUSTRIAL
SEVi'ER ORPOSAL SYSTEM �d $
. - O- DIS.c.-._-_--_-- 1.D0 WASTE APPROVAL -
CHARGES
i
-_ CONNECTION CHARGE FEE
OWNER'S PERMIT_ _1 00 ----- - ------------ — ----
REIMBURSEMENT FEE - -.
AUTHORIZATION TOTAL FEE V I e-1 APPROVALS_
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- DATE IINSPECTCR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE -DESCRIBED EXISTING DWELLINGTO THE. PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF i9_— CONNECT ADDITION.AL�- —
OWNER OR --BUILDING OR WORK
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(S) I �—^
_ADDRESS_.. _�` -_ AND/OR DRAiNFiF:LD ^_— _-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION CESSPOOLCJ DRYW ELL❑ I Y-
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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ----- - �"`-"-` -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
ABANDON
CALIFORNIA OR THAT I AM THE LEGAI,..��OWNER OF THE ABOVE
ABANDON HOUSE SEWER _j
DESCRIBED RESIDENTIAL P OPERTY. j BACKFILL SEPTI 2 TANKS[I �-
SIGNATURE �,r'.. I/ SEEP,-°_T(S) Ej CESSPOOLSE]
OF PERMITT
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EE - "�• -
IOHN A. LAMBIE, Co NTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLSG. INSPECTOR
/CZ, H.0. CASH
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