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HomeMy Public PortalAbout9705 WOOLLEY ST_Sewer__ 'CA E-66�12-sa APPLICATION FOR PERMIT 1 s a .ss DIVISION OF BUILDING AND SAFM SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING WM.J. FOX. COUNTY(ENGINEER ADDRESS CASSATT D.GRIFFIN,SUP'7 OF BUILDING * LOCALITY FOR APPLICANT TO FILL IN NEAREST a- n LEGAL D£SCR.IPTION LOT N0. v� .-_...�, OWNER BLOCK TRACTMAIL ADDRESS NO.OF BLDGS. Si7..E OF 1.07 NOW ON LOT _.__. CITY --.: ,. or r `c _t.'.. TEL.NO. USE OF BUILD M1GS DISTRICT NO. GROUP ! MAP SK PG CONTRACTOR '" ��r� `L""L � ADDRESS CONNECTION DATA ElCITY ) f,'V - {Fw`.. TEL, N �".F r }g- , $'t=,:716N DcP7H��..�-._�_.... -i3- n STATE MANHOLE REFERENCE _.LOWER.. .. REGISTRATION N0. 0 COUNTY - --. UPPER TYPE OFW,NNECTiON--- I ENG, F .0'M --- - NO. { DESCRIPTION OF WORK FEE -- Y. CURB P,L. _M.t 10 i eiQUSE'SEVER CO'VNFCTING'f0 �f _VPUBLIC SEWER ___ (1�--2.50 I HOUSE SEWER CONNECTING TO � .,..�PRIYATF DISPOSAL SYSTEM 1.0J_I_.__ _I� rT CONNEADD 10NAL.BLDG. OR CO IMP.NO, N(' CT Y19RK TO OUSE SEWER —.1.0-0 I ALTER OR REPA;R EXISTING I _ SEWER OR DISPOSAL SYSTEM 1.00 i TRUNK PERMIT NO. READ FEROIT NO, a DISC ON SECT AND ABANDON SEWER STATE ENCROACHMENT _ AND/_O_R DISPOSAL SYSTEM 1.00 PERMIT NO. UP --� SEPTIC TANK SEA PIT OR —'--�-- `� PITS.AND/OR DRAINFIELD 2.00. �' ,moi_ .+ '�, INDUSTRIAL - �I CESSPOOL DR WCLL — WASTE APPROVAL_' J SPECIAL CONDtT.ONS_ON_Li° 2.00 ( CHARGES OWNER'S PERMIT CONNL"CS'fON CHARGE FEE ! 00 _ AUTHORIZATION TOTAL FEE � o-- � r" I?E'.�teuRs MEN*FEE - I HAVE T141S DATE CONTRACTED WITH THE HER£EN NAMED CON- TRACTOR 'TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SiG:NATURE TO THE PUBLIC SEWER -' ---"- -" - SIGNED"THIS-DAY OF- __._ 19, ,_ NEV+_HOUSE SEWER OWNER OR CONNECT ADDITIONAL - -_ OWNERS AGENT- ^� _BUILDING OR W^S_��._,-_ SEPTIC TANK,SEEP, PIT($)�� - ADDRESS-_-- Al On VEAINFI I. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL 0 AND SPATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEW-ER OR v PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I Aid PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ni LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSESEW _ CALIFORNIA OR THAT I ATHE LEGAL OWNER OF THE ABOVE _ - -_ DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS 0 SEEP.PIT(S) CESSPOOLS 0 SIGNATURE OF PERMITTEE_ WILLIAM J. FOX. COUNTY ENGINEER VAMATION BY BL• f DEPUTY DEPUTY BY BY p DEPUTY ¢.. 'DEPUTY.:.. f � GAE420�2 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BJIL01NG ADORES,, E a + JOHN A. LAMBIE. County Engineer ----- WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST FILL IN 'ROSS ST !<AdaL 1LV __.. FOR APPLICANT T - ESCRIPTICN LOT NO ��C -;f'i _ �. d .T.�° �-I OWNER qr / MAIL. ` BLOCK IRAC'T' -"/ ADDRESS NO OF 5LDGS. SIZE'. » LOT NOW ON LOT � CITY i,.'—T- - TEL. NO _— USE O BUILDING # ^ _Ch) t D SRit;T NO. GROUP MAP PROCESS.EO BY r- BK FG CONTRACTOR �� ✓ _ 'f ADDRESS CONNECTION ATA c i7'YTEL .NO /__ .�1 STATION " nE P x. , M Cd ,fg STA IL r , R CIp !�LA 10N NO. _- ,fyL, COUAri tt'©LE HE F'ER�NCE COUNTY `.J h0DESCRIPTION OF WORK FEE .._—. _.-- _ — _ YYFE Or CONNECTION _ LENGTH FROM � )4 SOI.SE SEWER CONNEC'TiNG TO Y CURS P L y� M.L Ty}:F.L. . PUBLIC SEWER @ $5..00 1 n --- P.C._. ? P.C.NO O P I".'T'ANK 'SEEPAV. PIT OR // . PIT'S AND'OR DRAINFIELD @ S10.00 JOB NO, 'a')U' �SEWER CGN'v (, it UTO TRUNK PERMIT NO. ROAD PERMIT NO. --- - PR V E O "SAL YST EM � .53 00 1 ' L )NN c7 AoD,rioNAL BLDG OR AF'FIDA VI Y WAIVER Ehs ex ENT RECORD.IN.`>TR YO. DATE WORK TO HOUSE SLWFR Q 53.00 OViZRFLC%W SF ERAGE PIT,OkA1NF FL.D _._..._- X7 CE SP UL,DRYWEL: MANHOLE @ y __. -$5-00 1iWY.OR STWIDE . .N!.NG aL <TF4 REPAIRO ABANDON HOUSE ' � .... SEWER O ,aO.�At S S7FM $3,00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL - -- _--- — - -- CHARGES OWNER " PMIT 2f 60 — - — -— - ---- _—_ ____._.. .._—. --_— _ C ONN'.ECTION CHARGE'FEE AU:HORIZATION TOTAL FEE _. ---- — — -- —--- - I HAVE: AT THIS DATE A CONTRACT Wi7H THE HEREIN 14.4 REIMBURSEMENT FEE MED CON- ------------- - T'RACTO.R T'O CONNECT THE.ABOVE DESCRIBED EXISTING DWELLING .—__..._.___ TO T}i E. .>E .! .� APPROVALS DATE ?INSPECTOR S S'IGNATUR.E. SIGNED THIS rF.Y 9g a i OWNER OR NEW HOUSE SEWER - - OWNERS AGENT CONNECT ADDITIONAL BUILDING OR AN1D/OfiA"'FI FOI LD IT(41 _.. ~ C - T}1ATV R A./}i! p PPLtf,M71tlN --- ADrFarss - I II LS.E�Y Ac.hn. GD ANC± gTATE THA? THE ABOVE IS CORRECT AND AGR E TO COMPLY INITH. A L COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBINGANO .W ERS CESSPOOL ❑ DRYWELL [~ I HE E3.Y C .'TIFY 7'li ,✓[ AM PROf�EFy.,',Y REGI ERD AND/OR ALTER,REPAIR,SEWER OR LICENSED AS PEQUIRF Y LOS ANG UNT ANO STATE OF SEWAGE D4SPOSA 5YSTEM CALIFORNIA OR THAT ,;,AM ?iiE LEGA. OW H ANjl ! TEND O _ - — --- —'-- ---- RF_SfOE !N. TH AB :gyp ESURlBEU Rv pR J' D SCONhEt'T PLUG AND I F ABANDON HOl BE SEWER SIGNATURE OF PERMIT -y,4- '�: &�s'Ty # t BACKF.LL SEPTIC TANKSSEEP.pi"5:1 0 CESSPOOLS ffAMATION.— ROBERT A. WOOD �/ SUPERVISING MECHANICAL ENGINEER CK. M.0. ,F,'CASH ;/