HomeMy Public PortalAbout9659 WOOLLEY ST_Sewer__ :ESnR3.,E2 APPLICATION FOR PE MIT
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COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LkSMBTE, County Engineer _
WILLUM A. JENS& Supt of Building ACDREss '
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN
CROSS ST _
CESCN'lPAl
TIOPi� OWNER
f K� MAIL
BLOCK JTc R;aG 'S �, y �s4 �- ti,v: ACDRE55 y!
NO OF BLDGS. f
SIZE OF LOT - NOW ON LOT t� CITY _�-
Z�7
USE -
BUILDtNGS DISTRICT NO, GROUP MAP pRS2 £SSED SY
CONTRACTOR - / d` 9i' ri► 4 +-. ✓ qty �B f 4 y fi
K
ADDRESS _ gA�[ J. __.. — _ CONNECTI'L}N I.tATA .✓1 - _.-__
STATION 1 - DEPTH /
CITY �' TEL NO. � + 1` ' � -.
1
REGISTRATION r11 0 .. y. , STA'ic MANH0 Rf•,FEF>Er ---- --� f v_
r�JU NTY _ _ _' J C. 7 LOWS}Z
hi0_r DP SCRIPTIC�C� C) OftY FEE: -- ^�. -.. 7YP.
OF CONNECTION -� , LENGTH FROM '-
___.
i 1tCUS SEWER CONNECTING 7O 1 Y. C I'8P t M.L.TO P.L.
PUBL7C._SEWER @ SSS
—�SEP7I G.TANK SEE:PAGE PI"' EiR F CO lhlp NO JOB NO p
PITS AND/OR DRAINF'IELD $+O 00 -
rfRF SA :SEWER SAL NE TING iO TRUNK PERMI'7 NO .y' ROAD PERMIT N.O.
CoNNEE.DISPOSAL SYa7FM Ca+ $3.00 _ _ _ -- -_- _--_
f __ _ - ___ - -_-_____,_
WORK
AODIT JNALBLDG ^Cz en..[N€roT T_REC RD.INSTR Nt DATE
�WORK Tr'HOSSE SCWEft � $9.00 I � AFFIDhV17 WM1IY it I
- -�
OVER LOW SCEPAGE PIT.D.HAINF{ELD J..
A TN,CESSYOUi.DRI WELL.MANHOLE $5.00 - HWY. OR ST.WIDENING
-.-~.4 LTE R,REPAIR OR ABANDON HOUSE -_.__ _.__..__ .,�
SEWER OR D115POSA.L SYSTEM C� S3,00 ----_._
ENC ROAGN MENT
I PERMIT NO,
INDUSTRIAL
WAS1`E APPROVAL
OWNER'S PER�nIT ��- _-2' ----_-- i--
CHAR CS
._ _-.- - ----------_ - —- __..._._
AUTHORIZATION TOTAL FEE qN.N EC,Ti O''d ti.tIAUCE FEE
I HAVE. AT THIS DATE. A CONTRACT WITH THE HEREIN NAMED CON'- RE.f M.i3l R 11MENT FEE
TRA CR TO CONNECT I HE: AE3.0VE DESCRIBED EXISTING DWFLLING
70 THE PU.3LIC SEW ER,+y APPRO A DATE i INSPEC'TOR'S SIGNATURE
SIGNED THIS JAY OF_ _ ��.19
OWNER OR _ :� ! -, / NEW HO E EWER I
OWNERS AOENT CONNECT A✓DtTIONAL.
ADDRESS " '77 - ... T BUILDING OR WOR!C I -.
..�
-_ - -- SEPTIC TANK SE PIT(5)
I HEREBY NOWLEDG THAT I HAVE READ '7H1 APPI'ICA7I.ON ANO;Of DRAINF L D
ANC STAY_ THAT THE ABOVE IS CORRECT AND AGRE '_Q'Cr)MFLY
WIT`-' ALL. CCIUNTY ORDINANCES AND .STATE LAW €GL'LATING ---- -- -_- �
"LUM ING A!,40, SEWERS CESSPOOL �� DHYWELL El
1 HERESY
CER,IFY 'Th ";7� AM PRttPE REQ R OlSTERED AND/OR ALTER;RI'PAIS';SCWLR C:R -- - - --�- -----_- -_-
LIC:L,NSED AS RF'Q U.IRE LOS A-0LES OU h TY AND STATE OF SEWAGE DISPOSAL,SYSTEM
CALIFORNIA OR THAT •4M THE LFGAIL OW ER ND.,.I. D TFN3'p DISCONNECT PLUG AND
RESIDEfN l'�yF AB DESr R18tD F(.cStQ }R'L PR Y .4' ! ,
ABANDON HOUSE SEWER
SIGNATURE
OF PER Mj'G.?$ BACKF± L SEPTIC ANKS
SEEP,PI f>; f l CESSPOOLS C I
ATION ROBERT" A. WOOD
�'`� ° SUPERVISING MECHANICAL ENGINEER
76A6d2D
5 E•663 12.5d
APPLI:CATION- FOR PERMIT 1
&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEERADDRESS -- ._ �-
- CASSATT 0. GRIFFIN, SUPT OF BUILDING LOCALITY
FOB APPLICANT TO FILL IN NEAREST -
_..`---
LEGAL � r°T
DESCRIPTION LOT NO" F3 r OWNER
BLOCK `:j` TRACT_ MAIL
A_DDRES_S
NO. OF BLDGS.
SIZE OF LOT y-° .-- , ."'') + NOW ON LOT
d� CITY TEL, NO.
USE OF
BUILDINGS _ _ DISTRICT NO.„ GROUP fff MAP
.. I BK. PG
CONTRACTOR
ADDRESS CONNECTION DATA
C17?' TEL. NO, - - STATION DEPTH
_�_._...___._._. _____._ �--- _^�----�•-------.—.�STATE —,_ MANHOLE REFERENCE
REGISTRATION NO, ❑ COUNTY _ UPPER_ LOWER
TYPE OF CONK CT'IO:N LENGTH.FRO --
NO. 1 DESCRIPTION Off'WORK FEE Y. CURB P.L. M.L.TO P. .
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER q, $ 3.-'o1,----
HOUSE SE'AER CONNECTING TO
PRIVATE.DISPOSAL SYSTEM IOD
CONNECT AO.DITIONA.L$LDG. 6_R NO.
OB..
WORK TO HOUSE SEWER 1.00 CO. IMP, NO.! --N O.
ALTER OR REPAIR EXl TING
SEWER OR DISPOSAL SYSTEM _ _ 1.00 I TRUNK PERMIT NO. R II PERMIT N0.
�..
DISC
AND/OR DISPOSAL
IS CSAL ASYSTEM_ SEWER I.,,0 STATE ENCROACHMENT `#
PERMIT NO.
SEPTIC TANK SEEPAGE PIT OR —•'-
n S_A_ND/OR LRAINFIELD 2 „0 I I - INDUSTRIAL
CESSPOOL - DRYV=-ELL _ WASTE� APPROV. .,
I CiAL CONDITIONS ONLY 2 DQ CHARGES �.
— — CONNECTION CHARGE FEE
OWNER'S ER'S PERMIT_ 3 j 11 00
AUTHORIZATION TOTAL FEE li- REIMBURSEMENT FEE
- I HAVE THIS. DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DNELLING
TO THE PUBLIC SEWER
NEW HOUSE SEWER -
51C-WED 7":�I9S 17AY OF- - -- _1�3_.�__ ,
OWNER OR CONNECT ADDITIO?'fL
BUILIDING.OR WORK
OWNERS AGENT _
ADD1 S4 ,SEPTIC TANK SEEP,,PITS",
Aria Ok vRAIAF1EL
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYW£LL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COI,IPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR.
PLUMBING AND SEWERS. SEWAGE SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG ABAND - --- - -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFDISCONNECT
HOUSE AND _
CALIFORRiA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. .. BACKFILL SEPTIC TANKS
SEEP:PIT(S) Q CESSPOOLS❑
SIGNATURE - _--
OF PERMITTEE -
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION
BY i ,,0 5 C,'. 3 5` IN 3'I,,,# 4 4 JD
BY
DEPUTY p DEPUTY
Y f
BY BY Y
0 DEPUTY DEPUTY