HomeMy Public PortalAbout9726 WOOLLEY ST_Sewer__ _/v
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EA642D z APPLICATION FFR PERMI-;�
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
jOhN A. LAMBIE, Courtly Engineer ( � - } r. ., �
WILLIAM A. IENSEN. Supt of Building
LOCALITY yrs t�
FOR APPLICANT TO FILL IN CROSS SST. Y,
DESCRIPTION LOT NO. _� OWNER 1 � � __
.ryd, �L c Ig i
BLOCK TRP.£.:T y,,, ,p ,�v 'T P a'' :,._- ,q �DRESS
�.t'�
�i`,��r
NO, OF SLOGS.
SIZE OF OT NOW ON LOr CITY TEL. h0 r
USE ?F -.. �yy. �__.- ..
BUILDING D!STRICTi4fl. GROii{� MA FR O.,E55E6 F3�'
BK PG
CONTRACTOR
ADDRESs JSP ' ._: a # ' CONNECTION DATA
STATION +� J
PTH
CIT'Y ' 1 TFL E O_ j . ¢
`✓TATE
REGISTRATION NO � �� 3 � MANI-;CLE �"F'FRENCC� ,UFPFR
_.r couNTY
No j vESGRIP_)'tON CF '✓4'C7R KFEE TYPE:OF CONNECTION LENGTH FROM
,y. HOUSE SEWER CO NN ECT IMG TO ,.r Y. CU R13 L. M.L.TO P.L.
PUBLIC SEWER
d. _ ---,-�-
___--
P L NO
SEPTIC TANK,SEEPAGEPITOR
_ OBNO
PITS AND OR DRAINFIELD x70.00 I _._ CO ,?AP Nb ,f - J
HOUSE SEWER CONNECTING TO - ----- ,F!_NK PERMIT NO. . ROAD PERMIT NO. mes
PR lA TE DIS' OSAI, SYSTEM �p'3.STG r
I
iCNNEC7 ADDITIONAL FILD4; P.CAFFYDAVl. I w"fi'r_x Easrtwrhr 1I R€C-ORD.INSTR AO. i DATE
WORK TO HOUSE SEWER @ $3.00
OV ERf-i.flW SEEPAGE PiT,DRdINFik'.i_D
t STN„CES$ COl.DRYWEL.L,MA N1iCPLE @ I
$S.GO i
__. ___. _.__ ___._ __+.— HWY.O-RST.WIDENING
AL,ER,REPAIR OR ABANDON HQU_E i A„
S WER OR DISPOSAL SY'ST'EM C4� #3.00 STATE ENCROACH MENT
-
PERMIT NO.
INDUSTRIAL
+
WASTE
APPROYAA.
CHARGES
OWNER'S PERIdIIT �! - z oo -_-__-
--FE-----E -----_ - - CONNECTION CHARGE FEE
r
AUTI'IORIZATION TOTAL _ ..
- — -- ------ -- ----------- — -
REIMBURSEMENT FEE
! HAYE. .4T THIS DATE A. CONT.RACT 'WITH THE HERE?f! NAMED CON- ---.-------- ------.
TRACTDR TO CONNECT THE ABOVE DESCR�ED EXISTING DWELLING - I
TO T i fJBt.fC SEW EIk NEW HOUSE
-_ DATE 1 1*I PE.CT'OR S - GNAYURE
SIGNED THP
OWNER OR ` .. T _
G W N C R A C NT d J� yq`td' -
".`� - .:ANNE T ADDITIONAL
BUILDING OR WORK
AGDRFS Y}_+ �R - K.+ 5� - '- '✓a^7. f2'B 9.�„� _ __._.. _ - _, _. --I.. .__� ___ ____-- __-_
-- - SEPTIC TANK SEEP,PIT(5)
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR ORAINF'! LU 1
aNO STA'!E "fHAT THE, A13 IVF, IS CORRECT AT-40 /AGREE 'rc QOM PLV
VVirH AL: COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ✓-'-'- CESSPOOL- n DRYWELL
` tiEF ErBY CE'R IP'Y THAT' t ,YM PROP
€.RI R%¢'STERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS RFOLSIR1*O BY LOS ANGLES U TY AND STATE OF SEWAGE DISPOSAL.SYSTEM
G ALIFORWA OR TH4--(A AM THE L£2AL OW ER OF, AND INTEND T --- - -I- --” -- -
PLUG AND
RES?DE IN., THE A�S) DF_S(RIBE�1 RESf. N L PRO _ Y. HOUSE SEWER f -
�Y/J� �.. DISr,OaJNEC T
ABANDON H6
_
,
SIOF PER E'I SJIeiM- yy'�� r BACKFILL SF.PTIC TANKS
-_ ,I._ *
SEEP.PITS) ❑ CEa5POOL.S �I
TION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O.
ri-
f
ig&L•663 a..'SS APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWEI%%-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles B U I LDI Kv y,
WM.J.FOX, COUNTY ENGINEER ADID Ess ------
CASSATf G.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. vow•.-�.-ci w
LEGAL Y - -- —
DESCRIPTION_ LOT NO- �' i OWNER 'S
BLOCK �TRACL,,•: ? "`1Y AMAIL
DDRESS �� .-
t NO. OF BLDGS. ^---� - - - - --.
SIZE OF LOT NOW ON LOT CITY TEL,NO.
USE OF
BUILDINGS DISTRICT N0. ; GROUPMAP
.�_.... ' �' k--.._---- - 8K PG
CONTRACTOR
ADDRESS -i�-` �'- * `` CONNECTION DATA
CITYy<f'0i�;,.. TEL. NO. ... C ,_ S"tr STATIO4 V—_ DEPTH-
STATE MANHOL REFERENCE, UPPER
REGISTRATION NO. [f COUNTY -- _�`_.��__-_. _ LOW. R
ER
NO. I DESCRIPTION OF W(3RIl FEE --
TYPE 0 CONNNECTION LENGTH RO'Mr^`---�--_
-{If HOUSE SEWER CONNECTING TO Y, CURB P.L, M.L. TO P'L�
PUBLIC SEWER
HOUSE SEALER CONNCc...TING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT HOUSESEADDITIONAL BLDG. OR I ----- - _ P 0.
WOR TO HOUSE SEWER _ f.00i CO. IMP. N0. 1Q$ �I:1=
ALTER OR REPAIR La SS LING
SEWER JR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. '-ROAD PERMIT NO.
—I STATE ENCROACN
jl MT
DIS /qI NEAND ABANDON SEWER -� - E ---- —
AND/OR DISPOSAL 1._d1.00 oERMIT NO,
SEP
TICTANK, -'EEPAGE PIT OR ----------1 ----- -- -
dr- t PITS AND."OR DRAINFIELD _ 001 e, INDUSTRIAL ~-
WASTE APPROVAL
CESSPOOL i:RYWELL 1 --- -
A SPECIAL C NITIONS ONLY 2.0.0
CHARCES
�-'-- CONNECT QN"CHARGE FEE
OWNEWS ^PERI�4IT S 11 00 ---- ---- --`
RE:n ---
AUTHORIZATION 1 TOTAL HE
IfI=R E�SNr F�Ee
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- -p
TRACTOR TO CONNECT THE ABOVE DESCRI=ED EXISTiNv D`NELLING APPROVALS � DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER - NEW HOUSE SEWER
SIGNED THIS -DAY CF
OWNER OR CONNECT ADDITIONAL �" - - - -- ------` ---
OWNERS AGENT _ BUILDING OR VdORK
SEPTIC TANK SEEP. PITIS, -
I HEREBY ACKNOWLEDGE THAT I NAVE ROAD THIS APPLICATION CESSPOOL 0 DRYWELL Q
AND STATE THAT THE ABOVE IS COP4ECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR.,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICF14SED. AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFOR141A OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS L�.e
SEEP PITIS) Q CESS P40LS 0
SIGNATURE f �� — - - --
OF PERMITTEE_. Cis -( 4 ` ^—r
WILLIAM J.FOX,COUNTY ENCIINLER VALIDATION R.A.WOOD, CHIEF PLEG. INSPECTOR