HomeMy Public PortalAbout9738 WOOLLEY ST_Sewer__ DEPAUTIYR29t of COUNTY ENGngFJM SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY .PERMIT APPLICATION
COUNTY OF LOS ANGELES _
WILLIAM J. FOX. COUNTY ENINEER I BUILDING
GDDRESS
R APPLICANT TO. FILL IN LOCALITY �'�• ��^ j;•,�
BUILDING / ✓ NEAREST
ADDRESS CROSS ST. I�q �,�` �ex� •.�
LOCALITY - DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST A )-_ s S
CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ` r 14. 4 —,s—,s+,
MAILUSE ZO.N OCCUPANCY MAP
ADDRESS � I -� I -
BK PG
I-S
CITY TELAO. 00
CONTRACTOR r CO.IMP.NO.
/ l
-ADDRESS JOB NO.
CITY - TEL.NO. TRUNK PERMIT NO.
REGISTRATION NO. _ COUNTY
ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO. -
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
.USE OF
BUILDINGS CONNECTION CHARGE FEE '
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
7PUBLIOSEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER.CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 �Q
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM ' f.00
'DISCONNECT AND ABANDON SEWER -
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC.TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00- STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
..OWNERS PERMIT $ 1 00
Y. CURB. P.L. M.L.TO P.L.
-
AUTHORIZATION TOTAL FEE •C1 .
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO.R'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..-.--..-.-..DAY OF_..__.....___.:_. 19_____ ( `
NEW HOUSE SEWER '
OWNER OR_ CONNECT ADDITIONAL
OWNERS AGENT..... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..._......_..__
•--••---..............._......----._.....•-•._..,_.._.._...•-•-••• ANOYOR'DRA6NF4EtD"
I-HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSP00�DRYWELL o� I I f
CATION AND STATE THAT,THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR I
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT:1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT. I..AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RES1 TIAL PR PERTY. BACKFILL SEPTIC TANKS
I /� r SEEP.PIT(S) CESSPOOLS
SIGNATURE
OF PERMITTEE_._ .
._.._ .... . —.� _ —._.�
_ � �•--.
76A642A 663 7/53.
:EAL�B'aA5A2DPERMITAPPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION buILDING-
JOHN A. LAMSIE, County Engineer ADDF S
WILLIAM A. TENSEN, Supt of Building
LOCALITY "�` y-�_.. ��
NEAREST
FOR APPLICANT TO FILL CROSS
ESc;P Pi I.JN LOT NO
MAIL
BL_nCK TRACT ADDRESS
_r
NO OF PL DG". � V
SIZE OF LOT NOW ON :OT CITY TEL. NO.
USE OF
SJILDINC LISTRICT N 11111MAP PRO Ea B
IF,
ONTRAc oR r
-- Z-'- '- -•�, �, a
ADDRESS `gam � ,iJ p,� 1'+ f _� CoNNECTI®N DATA
I'Y ,• , J' TEL. NO. IE STATION _ DEPTH
,1-- COLJNTATE _ — 7'L UPPER
R ECs 15TRAT1.O IV NJ. MANHOLE REFER EN4:£ r �-
yy Tr _r' +� ±.OT7FE•Fr-,
N-0-7--DESCRIPTION DESCRIP7'lC�N OF WORK FEE TY+t of CONNECTION ENG71a FROM
r1 4C FEWER EONNECTING`YO ..! Y CURB P L. M.4 i0 P.L:.
IBtSI IC FW ERWE?.CONNECTINGC� 55.UD y,._ -_ - P C NO
SS
_--.._ -..
F TIC TANK, EEPACaE--PFT'
f FITS AND/OR GRAINFIELD @ $IO:00 CC._I MP NO
HOUSE SEWER CONNEET'iNG TO TRUNK PERMITNO ROAD PERMIT NO. OPRIV $300
jONNECT ADDi TICNA1 BLD G..CR A.F'IpAVIT I 1rA1vcR EO.S EM Eni { HEC_ORD, INSTR.NO. ! DATE Q j
WORK TO HOUSE S WER Q $3.00 (�
OVERFLCW SEEPAGE PIT,DRAINFIELD
ExTN;L`ESSPOOL;DRYWELL;MAF HOLE $ 00
_-_ HWY. OR S7.WIDENING
I .4 LTER.REPAIR OR ABANDON HOUSE
SEWER OR t1 5P05ASYSTEM @--$3.00 i STATE ENCROACHMENT
----, ! PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
OWNER'3 PERMITCHARGES z! Op _._.__- ___-__ —___ .
_ _
'CONNECTION CHARGE FEEAUTHORIZATION[TqiA
T1e RIZTIONTOTAF_E_E
1 HAVE. AT THIS DATE A CONTRACT' WITH THE HEREIN NAMED CON, REIMBiJR5_E h7EN7_t EE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISr;NG DWELLING
TO THE PUBLIC SEWER. APPROVALSDATE INSPECTOR S SIGE.
.NATJR
SIGNED THIS.. ___—DAY
I
OWNER OR NEW HOUSE SEWER
OWNERS AGENT,_._ - --- ---------".- _' -'- ------ -- ---
--------_--_-- '---'— CONNECT ADDITIONAL
ADDRESS
9UILDING OR WORK I
_ SEPTIC TANK SCEP.PIT(5)
I F?FRF_BY AC,KNOWLEDO THAT I HAVE READ THIS APPLICATION ANWOR DRAINFIFLb
A'tiD STATE THAT THE AROVE 11 CORRECT AND AQWFE TO _MP Ly � ._---.---------.----
W H AI : COUNTY e)R INANI:;ES AND S ATF LAWS REG I ILATING
PLUMBING ANDSEWERS. CESSPOOL ElDRYW ELL Q
IH
hF+3Y �:F•RTiFY Tt AY I AM PROPERLY REGISTERED AND;IOR ALTER,REPAIR,SEWER OR I
LICENSED ��-�•e RED 'T LC3";p4,NGLES C(TU T`t7Y AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL.I FRRN' {7R Tr{A 1 AM 7H £GAL OWNER OF. AND IN'T'END T'O -- - '-- i-- -,� --- '"--` - -"-
r .�_, DISCONNECT PLUG ANO
RE"-IDEN,..Y`N A9 „QSBC; �.ffiE-D RE5iDEP1T AL ppp, �jj�PER7"C. j
� .� . ABANDON 41UL,aE SEWER
RE
SIGNATU
OF PERMITTEE .�'? ,L- �._3 N"><"'+✓ �y P L„ BACKFILL SEPTIC TANKS .I _----~ - -
- „' -4� ,+L' ' SEEP,PIT is) CESSPOOLS
VALIDATION ROBERT A. WOOD
CFC. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
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