HomeMy Public PortalAbout9701 WOOLLEY ST_Sewer__ :EGOS 3r52
'6A6420 APPLICATION FOR ' ERIVIIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-
SEVk7GE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADORE,
WILLIAM A. JENSEN, Sup" of Building
LOCAL!
OrALI
NE
FAREST
(-ROSS
OR A �?,A FUL
PLI 3
_DESCRIPTION__ _ ____LCT_ OWNER A.
MAIL
CT
SLOCK _TRACT ADDRESS A lLk-.
NO OF ELOGS. `v
Z�
SIOF L OT NOW ON LOT CITY TEL. NO.
L
3 DISTRICT NO. GPOUR MAP PRQQ.;SSED BY
BK PG
CONTRACTOR
71
CONNECTION
ADD R F
clry6,, a TEL NO _STATIONS
TIQN ✓ DEPTH
T ljt Zj STATE MANHOLE REFERENCE F UP ..R
NO
RECIS COUNT
RATION NO,
x
DESCRIPTION OF WOR FEE 'TYPE OF CCII�MECTION', LENGTH FROM
ZSEWERCON-NECTING'T0---- Y. CURB L I ML.'VO P.L,Z_� CL
T.4 0 U;5
64.1 c 5 E v.,�--IR @ moo • 0
'NO
J,
EP IC TANK,SEEPAGE PIT OR % IS;
PITS ANO/OR DRAINFIELD @ $10.00 i� CO-I X
till
HOUSE SEWER CONNECTING TO TRUNK PERMil/h O. ROAD PERMIT NO.
PRIVATE 015POSALSYSTEt.1 $3,00
0
c6NNEc�-,,.6orr--ONAL 5LOG OR I AFFI13AVIT WATYER eA EM NT FECO RD.INSTR. NO. DATE-
WORK'F:O PI OU 5 E S E W F R $3.00
OVERF10'01 SFF,-AGE PIT,DRAINFICLO-
F.XTN CESS�00 L.DRYWIIi LA..MAN HOLE@ $5.00
HWY.OR ST.WIDENING z
RI rER RE:-AIR OR ABANDON HOUSE
WER CjIR DISPOSAL.SYSTEM @ $3,00
STATE ENCROACH MEN,
PERM:r NO.
— -P 11-
iNDUS"TRfAL
WASTE APPROVAL
CHARGES
OWNE ws -PER MIT s 2�1 00
CONNECTION CHARGE FEE
AUTHORIZATION Tom�Fi�--— -- - -•,-7,-'i --- ------ -------------- --
I HAVE AT THIS DATE A CONTRAC" WITH THE HEREIN NA'rr3 CON, REIMBURSrMENI FEE
TRACTOR TO 2ONNECT THE AS,:-�VF DESCRIStO EXISTING, DWELLING
r BI-I('. Sc-WER, APPROVALE
T THE PUS DATE I NSPECTOR'5 51 N4TUR
SIGNED THIS 19
OWNER OR
NEW HOUSE SEWER
OWNERS aGENT
CONNECT ADDII IONAL
BU�LDJNG OR WORK
AD
—S SEPTIC—T-A N K.SEEP PIT(5)
I HERESY ACKNOWLEDGE THA, I HAVE READ THIS APPLICATION AN.D/ORD RAINF?ELD
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMB
ING AND SEWER'S� CESSPOOL DRYWELL 1-3
HERES A ALTER, REPAIR.SEWER OR
F THAe'�'AM PROPr
PTT
1.�Y111 r L. 19 OR
A C'SP C. SEWAGE DISPOSAL SYSTEM
L-IiCENSED Ys N A`T I F
ISC NNECT PLUG AND
OR THAT& 4E 1.E�GALLCI�N AND !NTVN 0
RESIDE IN, ABO Ili. RkiSAIA I�P -,--
A AN N SEWER
a 00 HOUSE
SIGNATURE It 1
-ILL PTIC TANKS jf�3
eA,,KF SP i
SEEP,PIT I S) CESSPOOLS
ID TION ROBERT A. WOOD
K. M.0CASH, SUPERVISING MECHANICAL ENGINEER
, '
76A��4213APPLICATION FOR PERMIT1
S&EE•66663 72-5"h
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of-Los Angeles BUILDING
WM,J. FOX, COUNTY ENGINEER ADDRESS
CASSSATT 0. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO ITEC IN NEOS
SAREST
LEGAL
D£SCRIP7ION LOT E.O. OWNER - r�
$LOCK TRACT _�i,��-� MAIL
181
N0.OF LOT
USEc"STY; jGabriel: TEL.NCG. -C"�7.683
Of LOT NOW ON 1.0'i'
USE OF 4 --. .'. -
BU[LDI-`GS - - DISTRICT NO. GROUP MAI'
CONTRACTOR John N-s- Buchanan
ADDRESS 1,3244 E, Ramona ���+�s•,�_._ ., - � CONNECTION DATA
CITY,aldwin Pari TEL. NO. Ed-74213 `STATION DEPTH f�
rr� STATE MANHOLE REFERENCE
REGISTRATION NO. 1t 15,3 {ey - ❑ COUNTY _ u UPPER �_ COYER
TYPE OF CONNECTION LENGTH FROM
NO, DESCRIPTION OF WORK FEE Y. r.LaR n_+_ ..tiQ.L.-TO P,L,
I HOUS..Si'W R C9NNECrING TO ---
i
PUBLIC S E Vi E R t<U $
HODS" V4 c CON dECTING TO �y �py
I r 6VA�7E Di SPOSAL SYSTEM f 00 � .6 s..'6.J ---------- ---�- ��
CONNECT ADDITIONAL BLDG. OR
WORK RK TO MOUSE SEWER s 00 I� CO, IMP. NO.. JOB. No V J
aL ca OR REPAIR EXISTING T
D SPOS.L YSa EM 1.00 TRUNK PERMIT NO, ROAD PE,RMIT-NO.
uiSCUNV rt AND ABAkDl1N SEWER STATE ENCROACHMENT-- _
k D,'OR D POSAL YSTEM I.OD � i- -
---' __ ----- —____ >E#MIT NO. ._.._ _.—.—.__w.i
It TANK,,SEEPAGE YiT OR .y r� �,�y -
Pit ,fi$9/^81+' _1*m kw+E4L}�, f"�CO +,a1 VCJ HNOU IR:AL
"— _--- STE APPROVAL
L 5
C,6"
DRYWELL
SPECIAL.CONDITIONS ONLY
S N2.00 j CHARGES
-- ... — -h_.—
I'EE;lIT j—— CONNECTION CHARGE PEE
teie°F.Ii`S 5 T I OC
AU`MORIZATIO TO TAL FEE 51 00 RFIMBURSEM_ENT FEE
I HAVE TP'S DATE CONTRACTED WITH THE HEREIN NAMED CON- Yy �p
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING Da°JELLINI ' APPROVALS DATE INSPECTOR'S >ICNATURE
TO THE'. PUBLIC SEWER
5[GNEW HOUSE SENER
:r';E1�_(_HIS__DAY OF iS�_
OWNf R OR CONNECT AD :OVAL~
Oar{ 3UtLDING OR WORK
rj:F25 AGENT _---. - —'—
RDCTC';55.._
SEPTIC TANK SEEP, PIT.IS)
I c EREBY ACKNOWLEDGE_ THAT I HAVE.READ THIS APPLICATION CFSSPOOL I,J DRYWELL O
AND „.TATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
VI1TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGALTER, REPAIR,SEWER OR ^�
PLUMBING AND SEWERS. SEPIA, EPAIR,DISPOSr`.L SYSTEM
HEREBY L. '.7I F'Y D B 1 AM PROPERLY REGISTERED£RET AND%OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF,
CALIFORNIA OR THAT I Add THE LEGAL OWNER OF THE ABOVE +ABANDON HOUSE aEM+ER
DESCPIBEti RLSIDEN'iiAL PROPER?'Y. 3ACKFILL SEPTIC TANKS n
- SEEP.PIT(5) CJ CESSPOOLS 0 _
SIGNATURE
OF PERMITTEE
111/ILLIAIM J. FQX, COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY _
''�
DEPUTY L , ''DEPLTY