HomeMy Public PortalAbout9741 WOOLLEY ST_Sewer__ ' E-677
& 83 77.55 APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRESS_ J-
9 C.ASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY -
_ FOR APPLICANT TO FILL IN CROSS ST.
GINNER
DESCRIPTION LOT N0.
----- ---- - MAIL -
BLOCK TRACT ADDRESS -_
----- - NO. OF BLDGS. CITY - TEL. NOT # -
_SIE_OF LOT _ NOW ON LOT _
USE OF — DISTRICT NO. GROUP MAP
-B----UILDINGS----- --- --- BK PG
CONTRACTOR
—�— — CONNECTION DATA
ADDRESS
-- — -- STATION DEPTH _PP_ER_
CITY TEL. N0. ---- -- —�-
MANHOLE REFERENCE U
❑ STATE — LOWER
REGISTRATION
REGISTRATION NO. ❑ COUNTY
No. DESCRIPTION OF WORK FEE —
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3,S0 Y. CURB P.L. M.L.TO P.L. _
SEPTIC TANK,SEEPAGE PIT OR -
_PITS AND/ORDRAINFIELD
E PIT,DRAINFIELD P. C. NO.
OVERFL&WSEEPAG
EXTN.,CESSPOOL,DRYWELL,MANHOLE Cul' $2.00 CO. IMP. NO. JOB NO. A_
( HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM Cg'-$1.00 TRUNK PERMIT NO._ __ ROAD PERMIT NO.
t CONNECT ADDITIONAL BLDG.OR s STATE ENCROACHMENT v y`
WORK TO HOUSE SEWER $1.00 PERMIT NO.
~ ALTER,REPAIR OR ABANDON HOUSE T INDUSTRIAL
SEWE $1.00RD
_ WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT
AUTHORIZATION TOTAL FEE T — REIMBURSEMENT FEE
I HAVE AT THIS DATE ACONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT - SEPTIC TANK,SEEP,PIT(S)
ADDRESS _ AND./OR DRAINFIELD
^I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL❑
AND STATE THAT THE ABOVE 15 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 PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ -
SIGNATUPE _ _SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION.-...-'`°i ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
cK. Id.0. I-..CASHr
a E-6563 f f.85 F'
5APPLICATION OR. PERMIT 1
S&E.
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS
JOHN A. LAN1B8E, COUNTY ENGINEER
-CASSATT D.GRIFFIN, SUP'T OF BUILDING LOCALITY
l a
NEAREST
FOR APPLICANT TQ FILL IN CROSS ST, -
LEGAL —T— -�� —
DESCRIPTION__ LOT N0. �.'rf ,- OWNER _ � .
MAIL
BLOCK r. TRACT[r >: � T,, ADDRESS
+ .��
NO OF BLDG',
SI.LE OFSL"07 `' % NOW ON LOT CITY - SEL. N0. `m-.� 4/_
USE OF .� _
BUILDkNGS - I s DISTRICT NO. GROUP MAA FG
BK
CONTRACTOR
CONNECTION DATA
."ADDRESS ,�°Z'.✓ _ '�� �, t ;f, --- -----
STATION' DEPTH _
CITY TEL:NO.
_.
MANHOLE REFERENCE
� Q"tTATE -- — _ --- - -—LOWER
-
REG! TRAY{ N NO. ,/j. [f COUNTY
NO.� DESCK _-1-1. W
OF ORK FEE TYPE OF CONNECTION LENGTH FROM
- HOUSE SEWER CONNECTING TO 1 - Y, CT„RB P.L. M.L.TO P.L.
Pt1BLIC_S-EWER _ -
EPTIC TANK SEEPAGE PIT OR
-,
PITS.AND/OR DRAINF_IELD $3.0c.-
OVERFLOW SEEPADE PIT,DRAINF'iELD P. C. NO, -
EXTN CESSPOOL DR WE L,MAN HOLE $2,00 1 .I CO. IMP. NO. JOB NO.
^^
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM' _ Cr $,1.OG_� �'"1.� TRUNK PERMIT NO _ _--ROAD PERMIT NO.
T.
CONNECT ADD(TIONA.L BLDG.OR -- -- ---_ -� ---_----
I STATE ENCROACHMENT.T
WORK TO HOUSE SEWER _-51- Q I _ PERMIT NO,
ALTER,PEPAIR OR ABANDON HOUSE INDUSTRIAL
FEWER OR DISPOSAL SYSTEM ! -,-1,00_-___,_ _IV.ASTE APPROVAL
CHARGES
I --
-I
CONNECTION CHARGE,. FEE
OWNER'S PERMIT .. �—I—. t I oo - -- — --- ---- -------- ----
AUTHORIZATION -TOTAL. FEE -- - - REIMBURSEMENT FEE
---
I HAVE AT THiS DATE A CONTRACT WITH THE f{ REIN AMED CON- APPROVALS �_ DATE INSPE CT0F2 SSIGNATURe,
TRACTOR TO CONNECT-THE ABOVE DESCRIBED EXISTING DWELLING
TO 'THE PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED THIS—.—DAY OF f91---
CONNECT ADDITIONAL.
OWNER OR BUILDING OR-WORK
OWNERS AGENT—_______ - --- SEPTI("TANK,SEEP P?T{S
ADDRES5-_ _ --_-_- AND_/OR 0RAINFIELD
' HEREBY ACK-NOWLEDGE THAT I HAVE REAL) THIS APPLICATION I
DRYVJ ELL❑
ND STATE TI AI THE ABOVE ]S CORRECTECT ANC Af R4E "IO COMPLY ESS POOL[] J
'1STH A[L GCUN-Y ORDINANCES AND STk.7E LAW'S REGULATINGALTER,
.
REPAIR,SEWER OR
PLUMBING AND SrNERS. SEWAGE➢IS.POSAL SYSTEM
J. HEREBY CERTIFY THAT 1 RM PROPERLY REGISTERED ;3ND/OP, I
LICENSED AS REQUIRED Y LOS ANGELES COUNTY AND STATE O� DISCONNECT PLUC AND I
ABANDON HOUSE SEWER
CRL7 FORNIA. tjR THAT I) AMTHE LEGAL N£R HE,AC3O ' -- --._
^RI F,D Riy� �E PROPS V' d ,...`g, J',� BACKFILL SEPTI TT NKS CJ
�'F- SEEP. T,S. I_I CESSPOOLS
O PERMd TE09
JOHN A. L.AMBIE, COUNTY ENGINEER VALIDATION---- ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
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