HomeMy Public PortalAbout9711 WOOLLEY ST_Sewer__ >mEIPAET xT OF COUNTY ENGINEER ;, SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION -
COUNTS OF LOS "GEM
WILLIAM J. FOX, COUNTY ENGINEER „I BUILDING
1 ADDRESS P
FOR APPLICANT TO FILL IN LOCALITY � ��
BUILDING p qq NEAREST
ADDRESS CROSS ST.' C �J l/D
A— yg �r DISTRICT N0. Ready tor.Inspeotion PERMIT NO.
LOCALITY ` ._�..w.n .A D�
NEAREST
CROSS ST. RECEIVED BY DATE I ISSUED BY DATE
OWNER '—i*-
MAIL USE ZONE OCCUPANCY BK MAP- .
ADDRESS 1
CITY TEL.NO.
CONTRACTOR �e nQ �rbA Q,� �_; CO.IMP.NO.
ADDRESS^ yp/� �7 f
� ! �r_Y r�E{wr JOB.N0.
CITY tlV\ �M' � -TEL.NO. � TRUNK PER T NO.
REGISTRATION NO. (p Q' ® COUNTY
ROAD PERMIT
DESCRIPTION LOT N0. S�LJS�D pi.L�LYS�°oF STATE ENCROAC• ENT
4.girl PERMIT NO.
wLr /Yo
BLOCK TRACTtTiA'Aw 4&,#A- L gow co INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF ILDGS.
Iib NOW ON LOT WARP&
BUILDINGS /PCS Opl' G,fX,4-61- CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK. FEE
HOUSE SEWER CONNECTING.TO REIMBURSEMENT FEE
PUBLIC SEWER a $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
_
MOUSE
DISPOSAL SYSTEM 1.00 D�,
CONNECT ADDITIONAL BLDG.OR XCEPTION kECORDED
_ WORK TO HOUSE SEWER 1.00 0.
ALTER.OR'REPAIR EXISTING I DA4k BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND_ AND/OR DISPOSAL SYSTEM 1.00
SEWER 1.00 CONNECTION
L'''"PETS AND/.ORPTIC �ORA NFGELD•T OR 2.00 �;' `
_ STATIC D H
CESSPOOL—D RYW EL L
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REPERENC
�• UPPER LOWER
PE OF CONNECTION LENGTH OM
OWNERS PERMIT I Y CURB P.L. ' M.L.TO P.L
sF
AUTHORIZATION TOTAL FEE g -
i HAVE THIS DATE CONTRACTED. WITH THE HEREIN NAMED'
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..r.. DAY OF. Iq_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.......__.___..._ ....:.___. ._..:., BUILDING OR WORK
�.
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..._..__...._.._.._..._. ......_.___.�w`.___..._.__�._._.r.. ; AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT. I HAVE READ THIS APPLI 0 CESSPOOL' DRYWELL•0
CATION AND STATE THAT THE ABOVE IS CORRECT'AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS : ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY: REGISTERED.
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY, DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE J SEEP.PIT(S)0 CESSPOOLS D
OF PERMITTEE...r.��j.. -_. .
i6A642D 8&E 668 4/64 �i
` 0 -sz APPLICATION FOR PERIV[[T
'fiA6a.2.0
COUNTY OF LOS ANGELES SEWEk-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND.SAFETY DIVISION I BUILDING r
ADDRESS
JOHN LLIA A. L1JENSE, County Engineer _WILLIAM A.14. IETdEE1Y, Svp't of $vil3ivcy
NEAREST r
FOR APPLICANT-TO-FILL IN, CR055 T
r_EGAs_
DESCR!PT ION. L07 NO. f - / �dy.:' OWNER
MAIL
BLOCK T .� f1 f (aADDRESS
NO. OF 84DG5,.
J
f ,
SIZE OF LOT NOW ON LOT L�.�' C-,!7Y ,. .,- � 7£L.. NO. ,V ✓ � �- ,�� ,,�,,
USE OF
UIID N r yt9 DISTRICT NO, GROUP MAP PRO.ES5EL,SY
CONTRACTOii,... 8"w - "71 �`�"' -- d , 8K P
ADDRESS ` y � _ yt ___- CONNECTION D A
CITY
�q STATION L DEF TH
i
STA76 MANHOLE REFERENCE
REGISTRATION NO
_ y C7 COUNTY
- _
NO_I DESCRIFiTiGN O WORK FEF" TYPE OF CONNECTION
.- -
HOUSE SEWER CONNECTING YO }' CURB P M.L TO P L. Y
PUBLICSEWER @ _5..04 y x..:` ---f --_-_ - -- P.C.NO. _._. -
5EPTIC YA NK,SEEPAGE PfT' OP, .�
! PIT&ANDII OR QRAINFIEL3 @ $10.00
5IMP.NO.fY :YOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO.
PRIVATE D;S-OGAL.S 57 M Cg7 $ O(?
r CONY-c,T 4 WT-.ONAI.B nG C' - I Ar'FIUAVIT I WAIVER i EASEMi NT RECORD. INS-YR P Q DATE90
WORK TO HOUSE SEWER C v'9,00
OYERrLGh SL:"A F PITDR iN FIELD I �
EhTV `7.)L DRYWELL.,MANHOLE� —f-
"" $5.00
-
AL' Eft.Rt AIR OR ABANDON HOUSE. HWY, OR ST.WIDENING,. �
5EWEROR DISPOSAL SYSTEM, E3STATE ENCROACHMENT
PERMIT NO,
WASTE APPROVAL
.-__ ____ .___- ____._ _ CHARGES
OWNER°S PERMIT z' oo - --- -- -- ---
..--- -..-____.. -_-_-_ t -� CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE- AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FE
TRACTOR TO CONNECT TH �ABOVE DE-SCRIBED EXISTING DWELLING: ----- ---p9-;y ---c- - - - ------- -- ----- -- -
TO THE PUBL!C S yam, APPRO V ALy3' ! DATE IN5PEC TORS SIGNATURE
SIGNED THIS DAY OF --
y
OWNER OR gg���,,��!! NEW HOUSE SEVER '
OWNERS AGENT r �'°"^� YV CONNECT ADDITIONAL
BUILDING OR WORK
i
.___ - -- --- SEPTIC TANK.SEEP PIT(S)
I HCREB ACK OWt_Fn Gr THAT I HAVE' EAU THIS APPLICATION ANE/OR DRAINEi I f
.ANG 5 +TE ;?.a HE ABOVE IS CORRE'n. RN6 .AGREE 7f:1 COMPLY - --WITH
Ail. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLU MFIIN AND SEVV RS. CFqSPOOL r DRYW.LL n
I HER CERTIFY THAT _+�I+M PROPER RE. ,BRED APUD/OR ALTER,REPAIR,SEWER OR
RESIDE PIMA OR THAT 1HF LFc� GT., OU -.Y OND STATE OF
SEWAGE DISPOSAL SYSTEM
Lr'FNSEL� AS R OiJ iRF.D [?S A
L - /xt OW E OF. ANCI tNTE TO D SCONN ECT PLUG ANp �
THE Ik30V 5CRi0ED RF.SID PtT L P O RTY !
ABANDON HOUSE SEWER
SIGNATURE
OF PERIM, 1L.-L_: _ _14- _ BACKFILL$EP.SC TANKS I
_ _ JEEP,PIT Q$) [] CESSPOOLS !�I
fTIOI�i,'.. ROBERT A. WOOD
i SUPERVISING NSECHANiC.AL. ENGINEER
CK. M.U. ;,�CASHj -
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