HomeMy Public PortalAbout9712 WOOLLEY ST_Sewer__ DEPAIMIMElff OF IbWb= ENCS 1,
. SEWER—gMAGE DISPOSAL
DIVIS%ON OF .'BUILDING AND 'SAFETY PERMIT APPLICATION
COUWXY OF LOS ANGELES a
WILLIAM J. FOX, COUNTY ENGINEER
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+ LOCALITY
FOR APPLICANT TO FILL IN + .
BUILDING r '{ NEAREST y
ADDRESS / ® d CROSS ST. I /
LOCALITY em ? DISTRICT NO. SERIAL NO. PERMIT NM
NEAREST v: A ( � s
CROSS ST:, -
. �EcmB Ready far Inapoktion D SE ISSUED
OWNER
A
MAIL r ADDRESS USE ZONE O.CcC�UlPPAANCCY BK-MAP
PG
r�
CITY
CONTRACTOR e
Imp.NOW
ADDRESS
CITY' .81--ftaggTEL-NO: TRUNK•P IT NO.
t STATE i
REGISTRATION Np. I Z '71 H COUNTY. 'ROAD PERMIT
LEGAL O1�I F L iosi�-' GG/' J STATE ENCROACH T f
DESCRIPTION L NO'. O' • tS6 'd:(=. PERMIT N0.
CT
BLOCK .• �=TRA �v � � INDUSTRIAL.
- WASTE'APPROVAL
� -
SIZE OF LCT �p u NO'.OF 13LDG8. .-o( Q zy NOW ON LCT GES
USE;OF . � w
BUILDINGSy COHNECTION..CHARGEE
NO. DESCRIPTION OF WORK FEE REIMBU.R8E0IEN EE
HOUSE SEWER CONNECTING TO
PUBL C•SEWER- .0 $ $.50 RECElP 0. DATE BY
SE SEWER CONNECTING TO I
PRIVATE DISPOSAL.SYSTEM !'.0.0
CONNECT AODITI.ONAL•BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER. 1.00
ALTER OR REPAIR EXISTING NO- I DATE fr I BY
SEWER-OR DISPOSAL.SYSTEM 1.00 f'
DiSCONNF. T,AND ABANDON SEWER — r
AND. ISPOSAL SYSTEM I:oo CONN ION'DATA
—IMTIC.TANK.SEEPAGE.PIT OR
AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—O RY W ELL
SPECIAL CONDITIONS ONLY 2.00016NHOLE.REFERENCE.
- UPPER LOWER
TYPE.OF Cp RECTION P.L.' LENGTH'FROM
OWNERS. PERMIT $ _ 1 00'` Y. �C(1R6 PM.L.TO.P.L.
AUTHORIZATION TOTAL FEE yam'
1 HAVE THIS DATECONTRACTED WITH THE. HEREIN..NAME.D-
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXI8TING APPROVALS INSPECT.OWSSI_GNATURE DATE
DWELLING TO THE PUBLIC.SEWER
SIGNED THIS_.__:_. ..::.DAY OF.. _ 19 S NEW HOUSE SEWER ti f) �'r' V
OWNER OR: CONNECT ADDITIONAL
OWNERS AGENT... : -
_�_.:� BUILDING OR WORK
8E? I_.�.�_SLKn
ADDRESS:.._..._..... -•---....:.............. ........... ............... ` A�+4.4ue4w,+ D U s a
I HEREBY ACKNOWLEDGE THAT.1,'HAVE READ THIS.APPL'I- ' CESSPOOL 0 DRYWELL .�v 5
CATION AND STATE THArT.THE ABOVEAS CORRECT AND AGREE
T0.COMPLY WITH ALL COUNTY DRDIN'ANCES AND STATE.LAWS -A LTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1,HEREBY. CERTIFY THAT.-1 AM PROPERLY REGISTERED DISCONHECTPLUG'AND
AND/OR LICENSED AS REQUIRED. BY LOS ANGELES'COUNTY ABANDON HOUSE SEWER.
AND STATE OF CALIFORNIAp OR THAT I-AM'THE.LEG'AL OWN-
ER OF THE ABOVE D S RIBED ESIDENT.IAL PROPERTY. BACKFILL SEPTIC TANKS:[
SEEP.PIY(S) CESSPOOLSO
SOF PERMITia
TEE
7OA642A 603 7/53 ;`
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APPLICATION FOR P /
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION auItDINGC-k pp
JOHN & LAMBIE. County Engineer ADDRESS,
7
'XILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAR55T
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
'
DESCRilTION LOT N11. OWNER
Lk
MAIL
BLOC: ADDRESS
,4XI-1 t
B7
NO. OF SLOGS,
SIZE OF LOT NOW ON L�?T CITY 'TEL. .0. 12, J 1,
A�—i, ------
�pl� DISTRICT NO., GROUPPROCES
I MAP SED BY
USE OF %
BUILDINGS
T
CONTRA TOR
Ei T
A DDRESoy CONNECTION DATA
STATION DEPTH
TEL N
E
STATE
REI-ERENCE
R EG TH A 1 ION NO. N I OWER,
No. Df SCRiP*TiON OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSES WEk-6 6 i4 ENE�FC T IN 0 f0 YCURB
TO P.L.
PUBLIC SEWER -$5.00- P.C.NO.
SEPTIC
-TANK,SEEPAGE PIT OR
Yoe NO.
P!TS ANO OR DRAINT'JELD @ $10-00 `�!
HOUSE SEWER CONN ECTI NG TO ROAD PERMIT NO.
PRIVAT4015POSALSYS 1'rM @ $3.00 TRUNK PERMIT NO/
CONNECT—A661ETIOKAL BLDG.OR AFFIDAVIT WA—R EASEPENT RECORD.T?�STP NO:
WORK TO HOUSE SEWER @ $3 oo
OVERFLOWS-EEPAGE PIT-DRAINFUELD
EXT N.,CE5SPOOL,DRYWELL.M1NHOLE $5
-OWAUAN�DO-146— HW'Y, OR ST.WIDF-W NG
I-ALTEFE.REPAIR R N USE CROACH-
3POSA,SYSTEM @ $3.00 -TATE EN MENT
�EWEROR Dir
PERMIT NO.
WASTE APPROVAL
OWNER'S PERMIT 2� 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION T OT-AL-FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON'- REIMBURSEMENT FEE
TRACTOR TO CONNEECT THE ABOVE DESCRIBED EXISTING DWELLING
O THE PUSL�C - /I i
APPROVALS
T
SIGNED THIS DAY OF-
OWNER OR NEW HOUSE SEWER
OWNERS AGEN
CONNECT ADDI 1I.NAL
BUILDING OR'NOR K
z
ADDRESS
SEPTIC TANK.SEEP.PIT(S)
I HEREBY ACKNQW1E:W0E: THAT I HAV READ THIS APPLICATION AND,/QP DKAtNFIFLU
E 7 14 _F
THAT E: MP
LY
T
AN STATE -E ABOVE IS CORRZ T AND AGREE 70 CO Ly
WITH
ALL COUNTV ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL El DRYWELL
IHEREBY CERTIFY THAT M PROPERLY RrGISTFVfi� AND/ORAND%OR ALTER,REPAIR,SEWER OR
L'IC EN5ED AS REQUIRED '1L-0 5ANGLES '�,,,IXND STATE OF SEWAGE DISPOSAL SYSTEM.
T , .HE LEGAL
REQUIRED
0 1
CA OR THAT I HE _ALW IN Ell QF AND INTEND 10
- DISCONNECT PLUG AN
Rc: JE
F A ABANDON HOUSE SEWED!
OE IN, T� OVF-.' SCRIBED RES?-.. EN A L ROPES VY
SIGNATURE
FERMI E)ACKFILL 5EPTIC ARKS
OF
SEEP.,"
,S, ❑ CESSPOOLS LJi
mkCID) ION - ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH