HomeMy Public PortalAbout9716 WOOLLEY ST_Sewer__ >rD>rPAtvT of C0bNTY EN'GDMTBSEER E lAG.E DISPOSAL
niv SiON. OF BUILDING AND, SAFETY PERMIT APPLICATION
COVWXY OF LOS. ANG'rELU
WILLIAM J.- FOX, `COUNTY E:NG)mE@R BUILDING
,,I..ADD.RESS �l1�7Jf1,eeze
FOR A:PPL1C` iV r'TO.FILL. IN
LOCALITY .'�/yj01/0 C.
BUIL'D.INQ: .CROSS:STNEAREST
ADDRESS- .
LOGALIT1f
�,, .� .='3 DISTBMI
ICT`NO.. SERIAL N0. PERT N0:
;: p
NEAREA ST " .. �B.�.gti..P+ .5.
CROSS ST.
RECEIVED.BY Ready;for Ine.p"oo DATE ISSUED
OWNER
po.101
MAIL USE.ZONE: OCCUPANCY 'MAP
ADDRESS
J BKPG
CITY / 7E'L.NCd
r
CONTRALTO. Y
CO:IMP.NO.
ADDRESH '..:Le. tie L�oR;,.,1r6 ':
JOB N0.
CITY •k
9 "1'. . � TRUNK PERMIT N0.
• -•
REGISTRATION NO. .. : COUNTYi ROAD PERMIT NO..
LEGAL STATE:ENCROACHMEI�(T
DESCRIPTIt)N . LOT N0._,&C PEJiMIT'NO:
BLOCK TRACT P4Aff/� .�"1} V.1O 00 INQU$TRjA@�.
° A
SIZE OF LO.T. N0.bF:BLDG8. J
WASTEAPPROV.
'NOW O.N LOT / . CHARGES
USE'OF ..
.BUILDINGS 'CONNECTION CHARGE FEE
NG:. DESCRiPT1.OIN OF W .RFK FEE ""'�
:REIMB4JRSENEIY'1�FEE��
HOUSE SEWER CONNECTING TO _
PUBLICSEWER a $ 3.50 RECEIPT NO::
HOUSE-SEWER CONNECTING'TO
PRIVATE OISPCSA'LSYSTEM I.00 :. ..
CONNECT.ADDITIONALBLDG..OR EXCEPTION RECORDED
WORK TO HOUSE SEWER I.00
NO:. 'DATE BY
ALTER OR'.REPAIR EXISTING.
SEWER OR:DISPOSAL SYSTE00. I:00
DISCGHNECT AND ABANDO SEWER ) I
.AND/OR DISPOSAL SYSTEM I.00` GOIVNECyTI.ON .DATA
SEPTIC TANK.I3EEPAGE.PIT @ft•' =
11w . . . 2:00 A..: _ .S _ -.tib•
TATa� DEPTH•.
CESSPOOL—DRYWELL.
SPECIAL CONDITIONS ONLY 2.00: MANHOLE.REFS ENLrfi
"'xl2PPER' ..
LOWER_.
_ T•�IfPE OF CCNNECTION�-`- I,ENOTH.FRON '
PERMIT I QO Y. CURB • �S P.L. : . TQP.L..
OWNERS 3°
AUTHORIZATION TOTAL FEE:
77--
1
HAVE THIS DATE. CONTRACTED WITH THE. HEREIN NAMED
CONTRACTOR:TO.CONNECT'THE,ABOVE:DESCRIBED EXISTING, APPROVALS INSPECTOR'S SIGNATURE: DATE
DW..ELLIN'0.T.0 THE'PUBLIC',SEWER
SIGNED THIS;..,,.: _DAYjF
OWNER. OR. CONNECT ADDITIONAL i
OWNERS AGEHT:•r::.+ . _ . _.__. - -._ BUfiDi:NG.OR.WORK.
�.�. .._ /
AND/OR DR (NFIELD lT1S)'
1 HEREBY ACKNOWLEDGE.THAT I'.-HAVE READ THIS APPLI'• ; CESSPOOL DRYWE ..
LL
CATION.AND STATE.THAT THE ABOVE:IS.CORRECT AND:AGREE
TO:'COMPLY WITH ALL COUNTY ORDINANCES.ANO STATE:LAWS' ALTER . 1E OR
REGULATING PLUMBI.NBAN:D SEWERS. 8:EWAGE.DISPOSAL ORTEM.
I. HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED ' DISCONNECT PLUG AND.
AND/Olt LICENSED AS REQUIRED BY LOS .ANGELES.COUNTY'' " .
AND'STATE OF CALIFORNIA.OR THAT 1 AM THE:.LEGAL_:OW.N ' ABANDON HOUSE.'SEWER
ER-OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BA'CKFILLSEPT.,IC"TANKS
SIGNATURE Q
p SEEP.P.IT•(S) CESSPOOLS 0
bolo. E A/i'ttla�y f Via-
OF'PERMITTE
E
76A648A 66S 7/53
' soa 88
6806 .59
APPLICATION FOR PERMIT 1.
'
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
TORN A. LAMBIE, County Engineer ADDRESS - s
CASSATT D. GRIFFIN, Sup t of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL INCROSS
�-
LEGAL _( 6• c t.•
DESCRIPTION LOT N0. + ((��� ] OWNER J
BLOCK ' TRACT GY'} i#Y a�" l L t1 �t C >r, tMAIL
ADDRESS /
N0.OF BLDGS. ✓
SIZE OF LOT C) Z> NOW ON LOT E- CITY . TEL. N0.
USE OF ° DISTRICT NO. GROUP f P
BUILDINGS MAP ROCESSED BY e . �� � �. �r BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL.N0. STATION �� <�.-f DEPTH f
' ._ STATE MANHOLE REFERENCE
REGISTRATION NO. ❑ COUNTY /'LO ER
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO � .-,:'
PUBLIC SEWER @ $1.00 �' TYPE OF CONNECTION t LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR �0.
PITS AND/OR DRAINFIELD Y. CURB . M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL $ .00 —
HOUSE SEWER C0NNECT'!NG TO - f" f - ,, P.C.No.
PRIVATE DISPOSAL SYSTF,M @ Si-00 CO.IMP. NO. ' JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMITNO, ROAD PERMIT NO.
WORK TO HOUSE SEWER @ 1,00 3
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER 0R DISPOSAL
ISPOSA SYSTEM
@ 9.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 7 - :' REIMBURSEMENT FEE
I HAVE AT DATE AWITH THE HEREIN NMED CON.
TRACTOR TO CIONNECT THE ABO ET DESCRIBED EXISTINGADWELLIING APPROVALS DATE INSPECTOR`S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS. DAY OF " 19 �a NEW HOUSE SEWER
OWNER OR Ir l.r; �Iti, "4 CONNECT ADDITIONAL
OWNERS AGENT" BUILDING OR WORK
ADDRESSry.I -:�.`- _SEPTIC TANK,SEEP.PIT(S)
AND/OR:DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i AVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I,• M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESI9911A R TY. BACK FILLSEPTIC TANKS ❑
SIGNATURE f SEEP.PITS) ❑ CESSPOOLS
OF PERMITTEE
>P VALIDATION ROBERT A. WOOD
CK. M.O. �CASH SUPERVISING MECHANICAL.:ENGINEER-
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