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HomeMy Public PortalAbout9725 WOOLLEY ST_Sewer__ �y o42.D rbACgZD APPLICATION FOR PERMIT COUNTY TMENT OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION SUILDING 1 t A��Re s U IQE1N A, LAMBIE, County Engineer WILLIAM A. JENSEN, Sup'; of Building ' LpcAF..IrY fir"L+� L —— -- FOR APPLICANT TO FILL IN - �R©S�S�t-_--- .._LEGAL - _" _ _.__{'. _.._.. ✓ ^/-�^_ l' __ --_ - — t aESCR[P710M1i LOT NO ,,rte M A BLOCK TRACE ADDRE4S ,r NO. OF RLDGS, -°' y +'^�-•.a'' J _SIZE OF LOT NOW ON LOT CITY _ TEL. NO. , USE OF' DISTRICT NO GROUP MAP PROCESSED BY BUILD NGS _ L K PG _C'ON7 RACT LR.- .'gQ '.DDR > - ----- _CONNECTION_DATA CI('Y '� STATION = -1 f--DEP h _.{`_Vti TEL. NO. STATE MANHOLE REFERENCE LL MEGTTIRATION tJO. -yR`l �.�._. ,q - UUNTY NO. DL:SCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH M HOUSE SEWER CONNECTING TO -^ ✓ F. t7 A CJRB P L WL.TOP .. — EL ..J PUBLIC C SEWER C -NU �. SEPTIC TANK SEEPAGE PIT OR v'"SFO GO FMP NO, JOB NO. O PITS AND/OR ORAINFIEt.D u9' PR WA SEWER CANNES TfMG 70 PR TF_DISPOSAL SYSTEM TRUNK PERMIT NO: ROAD PERMT NO. CONNECT'xOLITIONAL ELDG OR --- -- ----- -- AFFiDAV1T w\[r€R Sas to EkT RECORD.iN5T4 NO DATE WORK TO HOUS SEWER S3.00 OVERFLOW SFF A('E PIT,DRAINFtELD - __.._ LXTN .ESSPOpL DRY WELL.MA N40LE 0 $5-64 i __ ____ _____ "__ r ., - "_- HWY.OR ST Wi.DCNING �.. ALTER.R,rt r�Al tiR ARAN DOFJ HOUSE -..- . SEWER OR UI PpSAL SYSTEM $3 00 STATE ENCROAC'. ENT - PERMIT NO. INDUSTRIAL WASTE.APPROVAL OWNER'S PERMIT z Do rONF:EC7I OF!CHARGE F'EE AUTHORIZATION TOTAL FEE ------ -- ---_----------- --- -- I HAVE AT THIS DATE A C ON7'RACT WITH THE HEREIN NAMED I-QN- HEiMBUR'ET.JEiJT FEE TRACTOR TO CONNECT THE AF30VE DE.SCRiSF_D EXISTING DWELLING ---_____ n.._______T----- TO T4tE PU SLrC SEWER. APPROVALS -- DATE I INSPECTOR 5 SIGNATURE SIGNED THIS f �__DAY OF OWNCROR 1 1J- r r NEW OUSE SEWER pWrJERS PGENY"_,L "�` ..r> yL ,.>�_✓1`� - T -_ —__ __—. __ y '-'� 3FEz - CONN ADDITIONAL !: ADDRESS r~, .. B ILDING OR WORK '�--1�- SEPTIC TANK..SEEP,PIT(S) HFREB-e ACKNOWLEDGE 7fIFT 1 HAVE REA'Ds_THIS APPLICATION AND/OR DRAINFiELD AND STATE.THAT THE ABOVE IS CORRECT ANP;1:AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND ST A'8'E-LAWS Rf_GULA`IiNG I PLUMBING AND SEWERS. CESSPOOL ❑ 6RYW ELL-l❑____J___-____�_._�_,_.__-__.:_.___.--___._ I HEREBY CERTIFY "HRT. I AM P. .�3PE RL E"�tSTr RD AICD/OR ALTER,REPAIR,SEWER OR L(LENSF_D AS RFQWRF, BY LOS AN JNTY ANO"y1ITATE OF SEWAGE DISPOSAL SYSTEM A. IFORNIA R THA j',AM TFiE LEGAL :,WAX OF, AND-INTE TO D14CONN EGT P.UG ANDT--�— -- ri tiiDE IN 'i'!T{.F AB OESCRiBEL RE Y71L .t2�Pc RTY 444 ABANDON HOUSE,SEWER j S,GNATUR£ OF PER ML"T--TEE d-,.� J yam" '� RACKFi LI SEPTIC TANKS SEE..PIT(S) ❑ CESSPOOLS [� LIDATIONROBERT A. WOOD CK� M.0' rA.. SUPERVISING MECHANICAL ENGINEER CK. M.O. � fY v 7PA E-663 12.54 APPLICATION FOR PERMIT 1 $8 •6fi DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL. Depm on of County Engineer County c1 Loa Ange168BUtLDINcT l WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OR SUfLOING LOCALITY r -�:�--- NEAREST FOR APPLICANT TO fiI.L IN CROSS ST. LEGAL DESCRIPTION LOT NO. ,.+'y^',� _ . . OWNER . BLOCK TRACT MAIL ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT s>r�. -.4 CITY - - TEL, NO. UsE OF BUILDINGS - DISTRICT NO, I GROUP MAP BKPG CON TRA CTO1t� - ADDRESS ..� k CONNECTION DATA CITY 4.. - ,XEL.-NO :. -y``.' r! Y STATION DEPTH ATE MANHOLE REFERENCE REGISTRATION NO. ,df .A Ci COUNTY UPPER -" TYPE OF CONNECTION LENGTH FROM N0. DESCRIPTION OF WORK FEE Y, CURB P.L. M.L.TO P,L. HOUSE SEWER CONNECTING TO _ PUSUCSEWER (a S 3.50 - �+ I HOUSE SEWER CONNEC`fING 1.0 PRIVATE DISPOSAL SYSTEM 1.00.i_ CONNECt ADDITIONAL BLDC. OR CO, IMP. NO. J NO. YJORK TO HOUSE SEWER }:00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00I TRUNK PERMIT NO. - ROA:9a PERMIT NO. —^ DISCONNECT AND ABANDON SEWER —STATE ENCROACHMENT AA2%OR DISPOSRL SYSTEM 1.00 _"- PERMIT NO. - J SEPTIC TANK SEEPAGE PIT OR ! PITS AND!OR DRAINFIELD 2.0.0 _ -Z, -, ,3 INDUSTRIAL —� CESSPOOL•DRYWELL �— i WASTE APPROVAL I SPECIAL CONDITIONS ONLY 2.00 I - CHAP.GES. - --- "—`--- ..--. CONNECTION CHARGE FEF W ONER'S PERM-IT $_�_ 1 � 00 - - ---_---_ —.--�---�_�._._.�.----- AUTHOR IZATIOI�T TOTAL FEE � �lI � REIMBURSEMENT FEE 1 -HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DAE___ _INSPLC.OR'Se GNATURE,_� TRACTOR 't0 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING __ TO THE PUBLIC SEWER _ NEW HOUSE SEWER SIGNED THIS-DAY OF' __19-- OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK___SEPTIC TANK SEEP,PIT($) ' I Ii HEBY ACKNOWLEDGE THAT 1 HAVE READ T141APPLICATION CESSPOOL 0 DRYWELL O AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ - ---------- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR;SEWER OR PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM I HEREBYERTIFY THAT I AM PROPERLY REGISTERED AND/OR - LICENSED AS R.EGIIIRED BY LOS ANGELES COUNTY AND ST r OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE,,,LEGAL OWNER OF THOVE ABANDON NOOSE SEWER _ DESCRIBED R6SiDENT PROP'.R Yr li / �BACRFILL SEPTIC TANKS _SEEP.PIT($) 0 CESSPOOLS SIGNATURE / i C� e s .. Z/6.,E-�'' ,...-✓ - -OF PERMITIrif rFlf'ILLIAM J.FOX. COUNTY ENGINEER VALIDATION BY BY - DEPUTY DEPUTY BY BY �� DEPUTY - DEPUTY