HomeMy Public PortalAbout9722 WOOLLEY ST_Sewer__ ,
&E-669%9.55 APPLICATION FOR PERMIT 1
>&E•66
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles 17_
JOHN A. LAMBiE, COUNTY ENGINEER ?CASSATT D. GRIFFIN. SUPT Or BUILDING {,
NEAREST '. .
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER "
_MAIL --
BLOCK TRACT ADDRESS
NO. OF BLDGS, 'CITY TEL. N0.
_SIZE OF LOT NOW ON.LOT
USE OF - -
BUILDINGS DISTRICT N0, GROUP I MAP
— -- .. BK PG
CONTRACTORADDRESS _ik.161_
CONNECTION DATA
STATION DEPTH
CITY zY TEL.NO. [ a { L✓ –�'-
- -+= MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO. �� ', y _ ❑ COUNTY ----
No DESCRIPTION OF WORK FEE -------- ._----.-----
I HOUoF SEWER CONNECTING TO _ TYPE'OF CONNECTION LENGTH FROM
PUBLIC SEWER _ @ $3.50 I Y' RB P,L, M,L. T P.L.
_I SEPTIC TANK SEE:PACF'PIT OR --- - ---� _–_ ----- –
d.---J PITS AND/OR DRA[NFIELD _ Crr_$.,,0_0_:
OVERFLOW SEEPAGE PIT,DRAINFIELD y –P. ANO.
EXTN.,CESSPOOL,DRYWELL,KANHOLE Q $2.00 CO..IMF. NO, _ ) NO.
HOUSE SEWER CONNECTING TO —� - -
L_–I PRIVATE DISPOSAL SYSTEM tc4 $1.00 CI b TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR ' -
I STATE ENCROACHMENT
YORK TO HOUSE SEWER_ – 4 $1_00 IPERMIT NO,
I ALTER,REPAIR OR ABANDON HOUSE -
SYSTEM $1,00 INDUSTRIAL
EWER OR DISPOSAL
--- –.---. .-_-- �_-- ",--_-- WASTE APPROVAL
CHARGES
– _ CONNECTION CHARGE FEE
OWNER'S PERMIT $ i REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �� 1_00
�c,--
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED APPROVALS DATE i4SPEC' JR'SSIGNATURE
CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING_DWELLING -
T"O THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS _.DAY OF ____ 99 - coNNtc.r ADatTloriaL– --- --–
OWNER OR BUILDING OR WORK l I
OWNERS AGENT----- i -
. `- SEPTIC TANK,SEEP PIT(S) .
DRA,,' l
I HERIDY ACKNQWLCDGE THAT HAVE READ.THIS APPLICATION CESS?COL❑ DRYW-ELL❑ `
AND STATE THA', THE ABOVE IS CORREC- AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT I AM PRDPER' Y "�EGIS'fEP.EU AND/OR ----- —_-- - — -------I---------`--- -DISCONNECT PLUG AND
-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ,
CAL:Fvttv1A OR THAT F AMTHE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
'DES£Ri..ED RESi DFNTIAL PROPERTY, BACY,FILLSEPTICTANKS❑.
SIGNATURE SEEP. PIT(S L CESSPOOLS V ', I
OF PERMtTTEE._ -+ CS,
I L
JOHN A.,LAMBIE. COUNTY ENCINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH
: SO8 3-62
'GFA6420 APPLICATION FOR PERMIT/
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
3
0 R1..
LOCALITY
A
JOHN X LAMBlE County Engineer A DORE
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
FN�EAREST
FOR APPLICANT TO FILL
LEGAL IN
DFSCR1PTiON LOT NO. o-NER
MALS
BLOCK TRACT FAID-DRE SS
NO. OF SLOGS.
,SIzE: or, LoT NOW ON LOT CITY TEL. NO.
U SE OF
UI ILDINGS DISTRICUM
T NO. GROUP MAP PROCESSED BY
B -_S '1v P
B K G
CONTRACTOR
A
0 tONNEQf1ON`DATA
ADDRESS
CITYTEL STATION
IATE MANHOLE REFERENCE
Y, Low,
REGISTRATION NO H EOUNT
--V 10 1—--r— �-4—-
NO, FEE LENGTH F-Rqm--
HOUSt. CTO 'A.L.TO P.Ltd'
S�WER CONN TINGECTING 0 PL
I , Y
rusLic SEWER @ $5.00 ! I 1 -4- --------
n- NO.
IC TANK--SFE0AGE PIT OR
_TfITS AND/OR DRAINrIELO S10.00 MP No-- JOB NO�
H
OU�E SEWER CONNECT14d,O
T NKI`ERMITNO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ s3,00 0
COKNECT DDiONAL BLDGOR
AFFIDAVIT-, WAIVER; EASC4EXI RECORD, INSIR, NO. DATE
AiT .
WORK TC.HOUSE',EWER 04
OVEPPLOW SEEPAGE PIT,DRAINFIELD
EXTN.CESSPOOL.ORYWELL,MANHOLE@ $5.09
HWY, OR ST,WIDENING
ALTEIR,F
&R ABANDON HOUSE
5ENVER OR DISPOSAL SYSTEM @ $3 DO A MEN
STA�STATE EN�FiOACH T qf
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
—- ----- CHARGES
OWNER'S
AUTHORIZATION TOTAL FEE OT CONqrcTTON CHARGE FEE
9p
REtMBUR6EMENT
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR T 0 C'o;I CT T°iF A90YE DESCRIBED EXiSTINr OMELLING
TO , US K, SFWER, DATE INSPECTOR'S SfQNATURC,
'HF
_ P L APPROVALS
SIGN]ED THIS
OWNER OR NEW HOUSE SEWER
OWNERS:
CC NNECT ADDITIONAL 7
pl ILOING OR WORK
SrPTIc TA141K,SFFI`PMS'}
NDHERE91Y ACKNOWLEDGE THAT I HAVE READ TH15,APPLICATION AND/OR DR%1NFIEL'Q
A STATL THAT HAT !'HE ABGVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
P L UMEI ING AND SEWERS. CES!1FOOL ORYWELL El
HE REBA' CERTIFY THAT I AM PROPERLY REGESTLRED AND/OR ALTER,REPAIR,SEWER OR
LICENSED
ED AS REQUIRED MY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM. THE LEGAL OWNER OF, AND INTEND TO -'5C-0N-Nec—TF;L1UGAND-
'RESIDE: s - 5AL PROPERTY. ABANDON HOUSE SEWER
THE ABOVF/X)ESUI IBFO RFSIDE�N�
SIGNATURE --_.---
.1 PF11,IiTTE1
VALIDATION ROBERT A. WOOD
CK. M.O. -c 5-9. SUPERVISING MECHANICAL ENGINEER
4-
j