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IL: wwnmaeng dpw.lacounty.gov PHONE: (310) 456-6621 FAX: (310) 317-4674 EMAIL: jking dpw.lacounty.gov Requested Start Date Spec No. SINGLE FAMILY RESIDENCE COMMERCIAL Job Address TRACT/PARCEL MAP Parcel Map/Tract Owner/Developer Contact Name Phone No. Email Fax No. Sub-Contractor Contact Name Phone No. Email Fax No. Signature Date I understand that I need written confirmation from LACWD before commencing any work. LACWD requires a minimum of two (2) business days to sched.

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