HomeMy Public PortalAbout9731 WOOLLEY ST_Sewer__ 6AA542
2E APPLICATION FOR PERMIT
4
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUIL=DING AND SAFETY DIVISION BUILDI IG
ADDRESS
JOHN A. I d11RIE; e junty Knginrer
COL.}'!A\ SG JF:SKitiS, 5up't. f Building ----
LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN _ ---
_-_-LEGAL
DESCRIPTION LOT NO. � _ -__ OWNER
,y* MAIL
BP.
LOCK "!yd TRCT Y'9_e" 45 -" 7- 7 ADDRESS
NO. OF ISLDGS.
S12E OF LOT NOW ON LOT CITY TEL. NO,
USE OF.—__��..__—_-_-_.
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
�C—.. --- BK PG
CON 7RACTOj
CONNECTION DATA
Ct �',J;y� - .✓Y �� STATION DEPTH
7Y, a_!./�+` %!�`".� ,,yy TEL. NO��. , f��O. 1�',��.''i-`�
LICENSE" LICENSE /,7
..� J { J MANHOLE REFERENCE ''. fir';f
�nj{
NO. �,; 1.,� ��� CLASS "�
NO,. t rDES"RIPTION OF WORK FEE T _ `Ear
TTPE O F CONNECTIO- LENGTH FROM
j HOUSE SEWER CONNECTING TO `� �..-I - Y CURB P.L. ' M.L.TO P.L.
I PUBLIC SEWER $ 5.00 (�j ---
£EPTTCG 'h P.C.NO. a
PITS AND OR DRAINFIE1.0 $10.00� 1 _IMP,NO. -__ JOB NOO
-HOUSE SEWER CONNECTING TO -� +
j PRIVATE DISPOSAL SYSTEM
$ 3.00 I TRUNK PERMIT NO. ROAD PERMIT NO. U
t CONNECT ADDITIONAL SLOG OR '— AFFIDAVIT walvca; EASEMENT RECORD.INSTR:NO. ATE
WORK TO HOUSE SEWER $ 3.001
�ALYEY7;R PAI2F-O4 ABAti()ON HPJ5E _ I L, _ -_D ---_
SEW£H OR OISPOSAL 5Y3TF.N 5 $. 3_00 Z!
`JETLf'[bW-SEEPAGE PT'1~, BgFA(Ff�fE:D- - �-" HWY.OR ST.WIDENING ua•L
EXTN„CESSPOOL, MANHOLE $ 5.00 - —
--- ------- --- S-ATE ENCROACHMENT
PERCOLA'ION TEST $ 5.001 PERMIT NO.
_- INDUSTRIAL--- —_-. - -_
WASTE APPROVAL
OWNER'S PERMIT -_-__-_-_ $T 00 _--_----- CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE ---
'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT ,THE ABOVE D�SCRIBED EXISTING DWELLING APPROVALS 1
TO THE PUBLIC SE% J DATE INSPECTOR S SIGNATURE
SIGNED THIS Dlovov OF, --_---
OWNER OR � _g ° ^f NEW HOUSE SEWER____ _
OWNERS AGFNt Kr,.,= ''t
CONNECT ADDITIONAL
BUILDING OR WORK
AO DRESS_______
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND 5TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ElDRYWELL ❑
I HEREBY CERTIFY TH AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REUUIRECf''lY 'LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM 111111
CALIFORNIA OR THAT iM THE/LEGAL OWNER OF/,SAND INTEND TO DISCONNECT PLUG AND -
RESIDE IN, THF. AB DESC FfPB'ED }3E IDENTf AIY/{',ROPERTY,
ey y ABANDON HOUSE SEWER
SIGNATURE ❑
OF PERMITTEE l BACKFfLL SEPT..-TANKS
SEEP,PIT(5) CESSPOOLS
VALIDATIO
CK. M.O. CASH
7GA642D APPLICATION FOR PERMIT
5&E.6S3 13...54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING g' I
WM.J. FOX, COUNTY ENGINEER ADDRESS 7
CASSA77 D. GRIFFIN, 5uv'r OF Buctalxc LOCALITY
r
FOR APPLICANT TO FILL IN NEAREST
a1Fr -.-
LEGAL ut � � k--
_DESCRIPTION LUT N0. OWNER k •- "'"_- _
BLOCK TRACT
,. u A �i'i's I M 4-6" •: e.ar PA A I L
ADDRESS C:.
SIZE•OF LflT ppj� NO. OF BLOCS. - `
'" "-t NOW ON LUT CITY .-3 --_d TEL.
USE OF
BUILDINGS DISTRICT NU-. GROUP AARP
BK PG
CONTRACTOR :. ,.,j� ,b> " .: ... _--
ADDRESS rb ;, COirNECTION DATA
CITY TEL. N -^ _SIAT)ON DEPTH
�.• -STATE - MANHOLE REFERENCE
REGISTRATION NO. y . >' s y' :� w;,,+�'� COUNTY '�-�, UPPE:R -, LOwER
TYPE OE`t4(}NNECTIUN LENGTH FROM
NO. F DESGRIPT ON OF WORK FEE•^ -- Y. CURS,� _ P.L. M.L.TO -'---
HOU E SEWER CONNECTING TO
�� PUBLICF4:ER_ $. 3.50 - -
-- HCUS£SEWER CONNECTING TO J --�'� Yid _-. �•..�
PRIVATE DISPOSAL SYSTEM 100 -
CONNECT ADDITIONAL BLDG. OR IN
ORK TO HOUSE SEWER 1.00 I I CO_IMP.NO.
ALTER OR REPAIR EXISTING
_i SEWER OR DISPOSAL SYSTEM -� 1.00 .i, _ TRUNK PERMIT NO. ,- -^ROAD PER,: NO.
DISCONNECTAND ABANDON SEWER � � STATE ENCRgACHMENT
AND/OR D1ISPOSA SYSTEM 1.00
SEPTIC TANKSEEPAGE PIT OR i"-` f �t7 PERMIT NO.
P".7 AND(OR I RAINFIELD _ 2.o0 ,fpy. INDUSTRIAL
CESSPOOL- DRYWELI_--^ --IITt-- kYAS'(E APPROVAL
rR.OVAL
SPECIAL CONDITIONS ONLY 2.00
_—..—._ CHARGES
- --.j—
CONNECTION CH'T FEET`
Ovam's PERMIT
AUTHORIZATION vTOTAL FEE --� x RFYhIBURSFM NF FEE
I DAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE (NSPECTUA�S Sii;NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
- ----- ---------------------
SIGNED THIS_ DAY Oi _._ .19_._ NEW House SEWER
OWNER OR CONNECT ADDITIONAL
- D__.I.
OWNERS AGEBUILNG OR WORK
NT_. _ -
ADDRE'35._ SEPTIC TANK, EFLP'. PIT(S)
----- - ---._..-- __—
AND/OR CP AI- LLD
I HEREBY ACKNOWLEDGE.THAT I HAVE READ T141S APPLICATION CESSPOOL❑ DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SE'R'ER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSEC3 AS RE9UIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER
DESCRIBED RES)DENT1ALa'ERr ER,T'Y:. ,.•,, BACKFILL SEPTIC TANKS
SEEPPIT($) 0 CESSPOOLS
-
=
s1eNArUa
OF PERMITTEES
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
11 3 y 7 2 1'1_,Y 2
f+_,Y ' 4 4.0 t
j
BY
BY
DEPUTY DEPUTY
r
87 BY �''d
Q DEPUTY 1 DEPUTY