Loading...
HomeMy Public PortalAbout9023 JAYLEE DR_Sewer_8/16/1955_sewer connection �76AS420 A P Id Lie I®f G�TIO C� / F® PERMIT • E-66 6 @ E-663 12•SA DIVISION OF. BUILDING AND SAFETY SEWER—SEWAGE ®I S ROSA L Department of County Engineer County of Los Angeles BUILDING WM.J. FOX, COUNTY ENGINEER ADDRESS G/ r4` ' CASSATT D. GRIFFIN;Sup,T OF BUILDING' ` p LOCALITY FOR. APPLICANT TO FILL IN r y�� CROSS ST.LEGAL DESCRIPTION LOT NOIR-� � BLOCK TRACT - ��'FI,u�•4 / MAIL ADDRESSNO. OF SIZE OF LOT - NOW ONBLOTS _ _ r �� TEL. �.' BUILDIUSE-OFN GS F ✓ IL �a..¢.'�C _ e r.. DISTRICT NO. GROUP MAP ,�. BK PG CONTRACTOR �-- +-� ADDR EqS s Lis(4_! jv ' CONNECTION DATA CITY / TEL. NO. v� STATION DEPTH �y ANHOLE REFERENC REGISTRATION NO. // �y,.� / ❑ COUNTY 9�pppp/....'-+� UPPER -- TYPE OF CONNE TION LENGTH FROM N0.' DESCRIPTION OF WORK FEE Y. CURB - M.L.TO P.L. f o - HOUSE SEWER CONNECTING TO � A_ PUBLIC SEWER t7a $ 3:50 (, HOUSE SEWER CONNECTING TO < PRIVATE DISPOSAL SYSTEM 1.00 CONNECT'ADDITIONAL BLDG: OR CO, IMP. NO. Y 56 j JOB. N0. _ WORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING - SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO: ROAD PERMIT,NO. - DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. - SEPTIC TANK, SEEPAGE.PIT OR ' _ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL . CESSPOOL- DRYWELL - WASTE APPROVAL. SPECIAL CONDITIONS-ONLY 2.00 _ ARGES - CONNECTION CHAR E FEE OWNER+S PERMIT S L .00 AUTHORIZATION . TOTAL- FEE REIMBURSEMENT FEE I HAVE -DATE- CON- TRACTORTTOS CONNECT THEAABOVE DESCRIBEDWITH THEH EREIN EXISTINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO-THE PUBLIC SEWE@- - - y A SIGNED TH 13 S �AY OF .� t4 1clS— OWNER HOUSE SEWER CA` 1 F i�J f OWNER OLl CONNECT-ADDITIONAL OWNERS GENT BUILDING OR WORK ADDRES ..ff - iLtT y A SEPTIC TANK, SEEP, PIT(S) _ AND/OR DRAINFIELD I HEREBY ACKNO ErE DHAi H VE READ THIS APPLICATION CESSPOOL C3 DRYWELL[I'AND-STATE THAT THE ABOVE ISTO. ECT AND AGREE.TO COMPLY _ WITH ALL COUNTY ORDINANCES- D STATE LAWS REGULATING ALTER, REPAIR, SEWER OR. -PLUMBING AND SEWERS. // SEWAGE DISPOSAL-SYSTEM - I DISCONNECT PLUG AND HEREBY CERTIFY THAT IU-M PROPERLY REGISTERED AND/OR DISCONNECT - 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 RESIDENTIA PERTY- .BACKFILL SEPTIC TANKS❑ /J SEEP.PIT(S) ❑ CESSPOOLS S SIGNATUREOF PERMITTEE - - WILLIAM J. FOX;COUNTY ENGINEER VALIDATION I< BY Co_6 6B,r9 4U) AUG 16. 4.5 DEPUTY - _ � ` f .DEPUTY ,By BY 1 © DEPUTY - DEPUTY