HomeMy Public PortalAbout9737 WOOLLEY ST_Sewer__ r
:E805APPLICATION FOR PERMIT /
'
6A642D �.
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
'DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FlCFl...'
NG-7
, - , -
JOHN A. LAMBIE, COUNTY ENGINEER SS f -'
COLEMAN W. JENKINS. SUPT. OF BUILDING
ITY. „ Sy
ST
FOR APPLICANT TO FILL IN ST. i<'v
--
DESCRtPTION—_LOT NO ,✓_ � ., ':�Yp� OWNER
,( MAIL
BLOCK TRACT /�,./�',� ADDRESSNO
OF BLDGS.
SIZE OF LOT NOW ON LOT J.' CITY / �i�'t'I TEL. NO.� 7.
r-
USE OF
BUILD NGS DISTRICT NO. GROUP MAP eY
.( / vim,, B K PGJOCE55ED
CONTRA TOR 4 ' `41'£ Cr4„-'G .
ADDRESS - P? l-� Ln�,vr j+��' 7 CONNECTION DATA _
-- ,y ' STATION t° 3 s EPT.H
CITY �� TEL NO. ,e .�
STATE rj ,r >;a p LIC ,+ ?' ..tom LIPPER�s-
LICENSE NO,;�' j gg J.•I - GLASS C ^' E- �-- MANHOLE REFERENCE
l 5' ''J �'i° LOWER
No. DESCRIPTION OF WORK" FEE ._..? '`
TYPE OF CONNECTION LENGTH FROM ='y
-_ r
1 MOUSE SEWER CONNECTING TO �(—� Y. CURB _ P L .+ M.L.TO P.L.
PUBLIC SEWER $5.00 0IM
SEPTIC TANK.SEEPAGE PIT OR M JOB NO.
PITS AND/OR DRAINFIELD @ $10.00 I CO. P_NO_
—__ —_
HOUSE I WER CONNECTING TO
PRIVATE�ISPOSAL SYSTEM @ S3.00
TRUNK PERMIT NO. ROAD PERMIT NO.
CONN EGT ADDITIONAL BLDG OR AFFIDAVIT wAIYER EASEMENT RECO RD:.INSTR.NO. � DATE I"
WORK TO HOUSE-SEWER_ - $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD i �^
EXTN..CESSPOOL.DRYWELL,MANHOLE @ $5,00
ALTER,REPAIR OR ABANDON HOUSE
HWY.OR ST.WIDENING
____.i—SEWER R DISOSAL .00 SYSTEM $3 --'_-""-
. ._O_-_ _P.`._ CROAC.HMENT -
j PERMIT NO.
—'- -------- — INDUSTRIAL
IrrI WASTE APPROVAL
OWNER'S PERMIT_ s i 00 - ----------cHARGEs
AUTHORIZATION TOTAL FEE -v CONNECTION CHARGE FEE
I NAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING —APPROVALS
TO THE PUBLIC SEWER. "DR— T�INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_ ------- --�
OWNER OR NEW HOUSE SEWER
OWNERS AGENT___
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
-- SEPTIC TANK,SEEP,PIT(S)
I HERFBY ACKNOWLEDGE THAT N I HAVE READ THIS APPLICATION
AND/OR DRAINFIELp I
ANDSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMB!NG AND SEWERS. CESSPOOL ❑ DRYWELL ❑ ��
II_CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM `
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE D CRI BE SIDENTIAL PROPERTY.
_}xA4S�.. � ABANDON HOUSE SEWER
SIGer
NATURE PE RE i"(, }�_ ,✓ y ;� ,g. BACKFILL SEPTIC TANKS ❑ �*T �'
OF PE:RMfTTEE .-_ — - SEEP,PIT iS) El CESSPOOLS: �^ "r
VALIDATION_.-- JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK. M._O. -'y CASH
N
76APPLICATION, FOR ■ ERMI ■ 1
E&',.c E•663 i�,..�d Eti
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Depwtment of County Engineer
County of Los Angeles BUILDING
WM..J. FOX, COUNTY ENGINEERADDR�ESS _
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
csoss sr, _
LEGAL
DESCRIPTION LOT NO. P ,? -. ..�— ,�? „t-y� / �z. ,,,. OWNER
BLOCK TRACT MAIL
ADDRESS
I:O. OF BLDGS.
S=OF LOT NOW_ON LOT - _-- ---- - CITY TEL. NO.
USE OF - --- _.-- ---
___
ILDINGS DISTRICT NO, f GROUP I EK ASAP PG
CONTRACTOR
ADDRESS — - CONNECTION DATA
CITY TEL, NO. STATION DEPTH
.�..,. _...,..•�._�..r......_�,r --- STATE MANHOLE REFERENCE
REGISTRATION N0. _ ❑ COUNT
NO.. j DESCRIPTION I TYPE F CONNECTION LENGTH FROM ✓`�
TION OF WORK FEE _ - Y. RB P.L. M.L.TO P.L
�� tIOUS'-'SEWERCON1Et.TiNG TO �� - �°•"
PUBLIC SEWER (a $ 3.50 --- -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 V' - -
CONNECT ADDITIONAL BLDG. OR ' „�
4YORK TO HOUSE SEWER _ 1.00 i� I Co. IMP. N0. +08. P tY
ALTE,R OR REPAIR EXISTING ( P —
i EWER OR DISPOSAL SYSTEM 1.00 � � TR[JNR PEI{G117 NO. 'SAD PERMIT' NO.
DISCONNECT AND ABANDON SEWER � SFp7C[NC.FcOACH1.IENT
AND/OR DISPOSAL SYSTEM 1.00 _PERMIT NO. ti
SEPTIC TANK SEEPAGE PIT OR - -
..—.' PIISAND/ORDRA_NFIEL6 2.001 INDUSTRIAL
CESSPOOL DRYWELL _— — WA-TE APPROVAL
CESSPOOL
L- DRY 30N5 ONLY 2.00 h
--I -- --- _ - Tom_ CHARGES `'�.�
CONNECTION CHARGE FEE
OWNERIs PERMIT �i ti_ 00
AUTHOR ATION I TOTAL FEE --- REIM WI'k,SE�MENT ®.—.�..____.- --------------
FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- ]� �'1e�;tp c+
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �' APPROVALS DATE._ INSPECTOR'S SIGNATURE
TO THE, PUBLIC SEWER �'� _----—�- '—�----�
SIGNED THIS DAY OF 19—. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
WORX
OWNERS AGENT —BUILDING OR
... .. ---.--- — -
SEPTIC TANK,SEEP,PIT(S)
ADDRESS
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[] DRYWELL❑
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 HEREBY CERTIFY THAT I AM PROFERLY REGISTERED AND/Oft DISCONNECT PLUG AND`
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF __
CALIFORNIA OR THAT I ANI THF. LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER__
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[]
SEEP.PITS) a—CESSPOOLS 0
SIGNATURE
OF.PERMtTTEE.__:._._.T.
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
.By BY
? llDEPUTY sv� r DEPUTY
BY BY
Q DEPUYY J-"Dr"PUTY