HomeMy Public PortalAbout9730 WOOLLEY ST_Sewer__ 766a
&-863 11.55 APPLICATION FOR PERMIT 1
3&E.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L
Department of County Engineer
County of Los Angeles 13UILDING
JOHN A.LAMBIE,COUNTY ENGINEER ADDRESS
J CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY s1
_ FOR APPLICANT TO FILL IN CROSS S
-- T. .-
LEGAL
DESCRIPTION __LOT NO. OWNER —
BLOCK TRACT ADDRESS
NO. OF BLDGS, CITY TEL. NO.
SIZE OF LOT _ NOW ON LOT
USE OF NGS — —.------ DISTRICT NO. I GROUP l MAP
BUILDI
— --� BK PG
CONTRACTOR _ y i- �. _ —� I �_
{ CONN CTIQN DATA
ADDRESS ' --- ----- ------
CITY t�,'�:J TEL. "C% ' STATION DEPTH
—
MAN14OLE REFERENCE
--_UPPER
'. ❑ STATE ---•---------- ----_---. LOWER _
REGISTRATION NO. 6 :,� COUNTY ,
No.7 DESCRIPTION OF WORK FEE
HOUSE SEKCONNECTING
— ER CONNECT--ING- -------------_--- TYPE OF CON CTION P. LENGT FROM
TC ` Y. CURB PM.L. P.L.
_4 PUBLIC SEWER @ $3.50 I -- ----- --- --- ---
SEPTIC TANK SEEPAGE PIT OR "---- ---- --"�—
PITS AND/OR DRAINFIELD C(g $-3.001 i
OVERFLOW SEEPAGE PIT DRAINFIELDI I C NO•
`r N CESSPOOL,DRYWELL,MANHOLE a $2.00 CO. IMP. NO, dNO.
EX
.._._i. _- - -- -- --
HOUSE SEWER CONNECTING TO �—
_}-
PRIVATE DISPOSAL SYSTEM (r §100 _ TRUNK PERMIT N0, OA ERM IT NO.
1 CONNECT ADDITIONAL BLDG.OR 1 STATE ENCROACHMENT
WORK TO HOUSE SEWER (n $7.00 I PERMIT N0,
ALTER,REPAIR OR ABANDON HOUSE
INDUSTRIAL.
SnvTR ORPOSAL SYSTEM -
—. - DIS (cti $1.01 WASTE APPROVAL ,,r
CHARGES
--- ...--------- _ -__ CONNECTION CHARGE FEE.
OWNERSPERMIT 1 00 ----- -'-' ----
---- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE--- � " z
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE IINSPEf;TOR'S SIGNA'T'URE
TRACTOR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC-S E'h'E12. NEW HOUSE SEWER
SIGNED THIS DAY OF —I9_— CONNECT ADDITIONAL
OWNER OR D3UILDING OR WORK
OWNERS AGENT „—: __ter. ---` ----. ...---- -------....----
"'� SEPTIC TANK,SEEP PIT(S)
ND/011 nRAI#-t ELD:..--
I Ii ERE.13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �
AND .STATE TH.T. THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSP(%Otl_] DRYWELLL7 �
WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I i
PLUMBING AND SEVVERS• SEWAGE DISPOSAL SYSTEM
I HEREBY CERT FY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
i
LICENSED AS REQUIRED DY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA. CZ THAT I AM THE LEGAL OWNER OF THE „ROVE --ABANDON HOUSE AND
WER
-- - .-ODS --=—._ ----.-�_—_.�-.-- —..----
DESCRIBED RESIDENTIA1. PROPERTY. BACKFILL SEPTIC TA.NKS_, j
SIGNATURE ' SEEP.PIT IS ❑ CESSPOOLS1
OF PERMITTEE. - - �`�-"•� - I
ft I I
IOHN A. LAMBIE, COUNTY ENGINEER i LIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
• ]Y. 9. CASH
tl
r
a6&' 1�
+sasazD 2 APPLICATION FOR PERMIT!'' r ..
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION sl ILDING g"
XOHN A. LAMBIE. County' Engineer AUDRESs tt— - - - --- "
WILLIAM A. IENSEN, Supt of Building
LOCAL.iTY_ ELI.-__-
N E_AREST ...�-^' �ry
CROSS ST :,., ,r ( .
FOR APPLICANT TO FILL IN _-_� ���� t-;� _ �.`�'�
LEr
DESC IPTION LOT�n K x �J _ t_.,'}� ,_ owueR
--. _._ MAIL - _• _.-- -_-` .-(j-. ..L--_. __._ _._ •_
M F
!'FGACT ,�,�
ADDRESS
NO. OF BLD GS.
SIZE 0= LOT NOW ON LOT ".,�""• CIT'Y TEL.. NO.
USE OII d" p ,,,r+j D!ST'RI'^T'No GROUP, MAP - PROCESSED BY
K PG
CONTRACTOR vw ✓Pa'' �'- w^y " 9 T,a f�Jr Yom ' _ J_� j 'fir __
ADDRESS
) = CONNECTIdTd DATA
CITY TES NO. STATIONY`-3 y / DOTH l
,o.�,y .,•+{ C STATE MANHOLE R,E'FERENt.:-E: d _ r IIPPfR
R GIL�TR AYION u0 �0 ,7 ,mac _L OliNl'Y --TYPE yr C.C•.3l ria.:"'I O'v �_ - LENGTH FRO NO. � DESCRIPTION OF WORK FEF. _-- — - < =--" -- - 7 - -----
itYC USE SEWf'R ONNE TING
TO Y. CURB R(� M.L, i0 P.L.
-:_ '1- Yrk
MPNG :- r—NO.Y BLIC SEWER 1 0
SEPTICTANK SEEPAGE PIT OR JOB NO.
S :NCr�ORAFNFIEg<000
HOUSE SEWER CONNECTING TO I TRuNe,PERMIT NO. ROAD PERMIT NO. 09
PRIVATE DISPOSAL SYSTEM @ $3.00
W.yH4G TO ADDU TIONAL SEWER
OR �� $3.00 r ___ I
r
WORK
SEEPAGE ER BHAfNFICLD - P"f IDP V17 x+Aia R EA EMihi I RECO"ED IYVSTR NO BATE
1
I EXTN .r
.CES BPOOL;DRYWEe L,MANHOL." ?Fn.00
-.. _-_— ANDD ._.._. _ F4WY..O-25T_W`Df`1tNG-
ALF R.REPA R OR ABANDON HOUSE
SEbV�R OR;IISPOSAh SYSTEM $3.00 ; _--_-_. STATE E.h..ROACiiMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER-7S'7 PERMIT T-
00 - HARGES
- --- -- --
- - -
CONNECTION. CH PVt FEE
AUTHORIZATION TOTAL FEE --
( HAVE: AT IIti7S` DA-,r A CONTRACT WITH THE. HEREIN NAMED CONREIMBURSEMENT FEE
- ------- - ---- ----
TRACTOft TO CONNECT THE. ABCVE DESCRIBED EXISTING DWELLING APPROVALS -�
0 THE PU 6LIC Sr'iWER. DATE i INSPECTOR'S SIGNATURE
SIGNED
SIG.FaEPJ THIS--DAY
OWNER OR NLW.HOUSE SEWER -
OWN=.RS AGF NT"_. _..—_ ___-_
CONNECT ADDITIONAL .
ADDRESS_-.-__
BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
I' bb4,5:SY ACKNOWLEOGH THAT I HAVE READ THIS APPLICATFON AND,ilR ITR.AfN€''!Ef_D
ANC STATE THAT T'HE ABOVE1.5 COei -CT AND AGREE TO C4 Mf+LY
WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING '
PLUME3I PfG AND SEWERS, ESSPOOL ORYWELL. ❑
' HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDj OR ALTER,REPAIR,SEWER OR
LICENSED. .AS REQUIRED BY LOS ANGLES Cbi:NTY AND STATE 0 SEWAGE DISPOSAL SYSTEM
CFI!i=ORNIA OR THAT 1 AM THE LEGAL_ OWNER O.F. AND INTEND TO DISCONNECT PLUG AND
RESJDE IN, THE ABOVE D SCRIBED RESIDE'NTfXROPERTY'
ABANDON HOGS'"SEWER
SFGNATURE
h
OF PERMYiTE€ 1, '^'r"+d 6+' '"`-..�_ `- °". BAC KFt LI.SERTIr TANKS
SEEP.P.ITtSI r .ESSPOOL}N '�
VALIDATION. .., ROBERT A. WOOD
CK. M.O. <!CASH
SLIPERVISING MECHANICAL. ENGINEER
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