HomeMy Public PortalAbout9706 WOOLLEY ST_Sewer__ 76A6420
E-60�ia.sa APPLICATION FOR PERMIT
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DIVISION OF BUMI)ING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County of Los Angeles BUILDING `-
WM.J. FOX, COUNTY ENGINEER ADDRESS � 7,261,
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO ML IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
NO. OF BLDGS,
_SIZE OF LOT NOW ON N LOT �- CITY TEL. NO.
USE OF _
DISTRICT NO. GROUP �. Ai AP BK PG
CONTRACTOR
ADDRESS r..° .I CONNECTION DATA
CITY U- 4Wj'0,-It, TEL. NO. Y {_ ,v, ' STATION DEPTH - -_
9- (� STATE MANHOLE REFERENCE
REGISTRATION NO. '` ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
NO. i DESCRIPTION OF WORK FEE Y, CURB w- P.L__ MA TO P.L.
HvUSE EWER CONidEC71NG TU
_PUBLIC SEWER (� $`3.50 I �� ---.---- — -
HOUSE SEWER CONNECTING TO
A--:_P_RIVi:TE DISPOSAL SYSTEM 2.00 I i ---_�-�------- -- -
CONNECT ADDITIONAL BLDG. OR PNO ' JOB, N0.
! WORK'_[ CO.. , ._O HOUSE 1:00 _ _
ALTER OR REPAIR EXISTING
VIFITRUNK PERMIT NO. -� ROAD PE R M I T NO.
R_OR DISPOSAL SYSTEM 1 E00-��
DISCONNECT AND ABANDON SEWER � SThTE ENCROACHMENT
ANDIOR DISPO..AL S STEM 1.00 .—,— PERMIT NO. i
SEPTIC. TANK SEEAGE
PP!T OR v
PITS ANI)/OR DRA_IMFIELD 2.00 s#'°' ' ID INDUSTRIAL
CESSPOOL- DRYWELL �!' WASrE APPROVAL
SP€CIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNEWS PERMIT 11 OO
AUTHORIZATION TOTAL FEE j � I0 c, RFi MBURSEMF.NT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APf4 ROYALS DA"f`E iNISPECTOR'S IGNATURE
TO 714E PUBLIC SEWER NEW HOUSE SEWER --
SIGNED THIS DAY OF - _.19^ —
CWNER OR - CONNECT ADDITIONAL i{ �-
OWNERS: AGENT.— _ _ _BUILDING OR WORK _---
SEPTIC TANK, SEEP, PITS)
_AND/OR DRAINFIELD ..
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1HERE9Y CERTIFY THAT I AM PROPERLY REGISTERED AND%OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY-AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I ANI THE LEGAL OWNER OF THE ABOVE HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
VEEP.PPIT(S)0 CESSPOOLS 0
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
6Y BY
DEPUTY - DEPUTY
BY BY t
DEPUTY - - - DEPUTY
:EAD83_�z
'EAsazD APPLICATION FOR PERMI-'Il"
COUNTY OF LOS ANGELES SEWER---SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
ING
JOHN A. LAMBIE. County Engineer __---
WILLIAM A. JENSEN, Supt of Building
ITY
ST
FOR APPLIC l-•TQ-FI � fJ 7 T
DESCRIPTION LOTNO, O 4NER
MAI C
BLOCK TRACT � ._ .�"'�' JZ - q 'ADDRESS
_
NO OF BLDGS,
CTY
512E OF
U LLOTPW- LOT
C --" DIISTRiCT NC. GROUP TEL,
EMRP O PR CC65F_O BY
3r ,�
BS1 S �`
IL
CO NT RA CT0R� nll~ ' 3•.dA' .:y �° �J'::-�� t� / _t 4
ADDRESS
CONNECTION, AT
1
.STA..ION >, DE PTh
CITY - d .LLL_--- TEL NO �
STATE
REGISTRATION NO. - � COUNTY MANHOLE R FFRI E ---
NO.. 7 SEWER $5ON DESCRIPTIOF WORD FEF' - _--T -'-- UN
_{ _ _ TYPE PEO C6NN I:YiLENGTH IR,6M
I td 3US SEWER CONNEC"ING TO _�7 —_ Y C.0 RB '� L RP.i_ 7O P,G_
_i z UHtf;. .UD �> P c.P10. —s--
___ _ __ _.. __.— __-_ __ r,,. __.
i s LPTIC TANK.SEEPAGE PIT OR �y
f •$&� IMPNO- JGH NO 444mmm
�Y175 ANL'!OR DRAINFIECD Ca $10:00 ".�. -_
H(`Ub. SEWEF2%ON NE TING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPO SAI SYSTEM @ "{.x.00 _
JN°aEc7 ADDITIONAL BLDG OR AFFiOA V!T Tw.4ivrR er.s rtn[vt r RECORD.INS 7R.NO.I� DATE
WORK TO HOUSE SEWER @ $-'.DO
-._.-__ O ___. r-.
OVERFLOW 5&E?AEE Pt,,L'RAINFiELD
i
E XTN'..CESSPOOL,DRYWELL.MANHOLE G $5.00
__.. ._ __._.. _...____. HWY.OR ST.WIDENING
' ALTER.,Rf P.A IR OR ABANDON HOl15E
' S VV R OR DfSPGSIL SYSTEM @ 93:00 S7ATEENCROACHMENT
i . PERMIT NO.
INOUSTRIAL
' I WASTE APPROVAL
CHARGE
OWNER'S _-___
CONNECTION CHARGE:FEE
AUTHORIZATION TOTAL FEE
J /- REIMBURSEMENT FEE
1 HAV AT '7i175 DATE A CONTRACT WITH TSiE HEREIN 1�.4 MED CON-
TRACTOR TO.CONNECT THE ABOVE DESCRIBED EXI5TiNG. DWELLING --- /�`r T - --- - --
TO Tr{E PUBLIC SEWV,fl•y; - A6�'ROJYA4 Y DATE TIN EC:TOR SIGNATURE
�d �'a I°S g` ✓` I
SIGNED THIS_�,,, DAY OF__ye�'b'!..-'�
OWNER 0RNEW HOUSE SEWER
s
OWNERS AGENT--24'
� ~� CONN ADDITIONAL
BUILDING OR WORK
ADDkf S5a-Al - y.
- - 'PT IC TANK.SEES- P!T(S)
HE FL?Y AC KNOVVLV✓L ED. = THAT ! HAVE READ THIS APPLICATION '
AND STATE. 'THAT. THE 1BOVE 1.5 GOP,RE^_T AND AGRCE
AND!Ofi QiZAiNFIEL.D i I
WITHALL f.i:JNTY :1PDiNANG ES AND STATE L,AW,S. RCGULATING
FLU M81N G AND SPINE.ti'S _ CESSPOOL. D DRYWELL n �
NERKBY CERTIFY TH T'`I SAM 7°RO PE 1L R STEAED AN')/OR ALTER REPAIR,SEW.FR OR
L!C.ENSED AS REQUIRE °¢ i_05 ANGLE'-+ OU GITY AND STATE OF SEWAGE DISPOSAL SYSTEM
E'A L:F'}RNiA OR THAT XM THE L£G ALOW�tER F, AND INTEND T "--"--
RES.105 IN, T E ASOV. ESCRiHED Rt7SIDE A 'RO $RT'..:Y DISCONNECT' PLUG AND
ABANDON HOUSE SEWER
A I
_,-
StOF, LRE �. yI' e'"��L ✓ ,4¢j BA KFILL SEPT(CTANKS Q
SEEP.PIT(H) LJ CESSPO GLar !J;
DATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
,• CK. M.O, [ASH
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