HomeMy Public PortalAbout9023 JAYLEE DR_Sewer_7/23/1959_alter sewer ceaoe•e-sa COUNTY OF LOS ANGELES SEWER-SEWAGE DOSPOSAL
DEPARTMENT OF COUNTY ENGINEERIII
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BUILDING AND SAFETY DIVISION ADDRE SG (Q v/^
JOHN A. LAMBIE, County Engineer _
CASSATT D. GRIFFIN, Supt of Building LOCALITY
If,•_ :° o.'Xl ., NEAREST,.
FOR APPLICANT TO FILL-IN CROSS ST .=
LEGAL
DESCRIPTION LOT NO. DINER
BLOCK TRACT 7 5_'* ![ MAIL
7 ADDRESS9d /)
v SIZE OF L04 N0.OF BL
�e NOW ON LOT
- CITY fb�•-t ' GGJ`�� T N0. /
USE OF r•_: <. ':
BUILDINGS DISTRICT NO.H GROUP MAP PROCESSED BY .
BK PG
CONTRACTOR
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ADDRESS O CONNECTION DATA -
^' CITY. TEL NO. _3_4
y ( STATION DEPTH
STATE S UPPER.
oA REGISTRATION NO. - ® COUNTY MANHOLE REFERCE
No. DESCRIPTION OF WORK FEE _ LOWER
a
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $8.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION -. LENGTH FROM
PITS AND/OR DRAINFIELD @ $8.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.•IMP.NO. JO 0.
CONNECT ADDITIONAL BLDG.OR. TRUNK PERMIT NO. 0 PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REP"' aB AaAN4)ON HOUSE q STATE ENCROACHMENT
SEWER^ '+'cone &M @ $1.00 l PERMIT NO.
INDUSTRIAL
_ - WASTE APPRO L
CHARGES
OWNERS PERMIT g •2 00 " CON NiATION CHARGE FEE
AUTHORIZATION TOTAL FEE c REIMBURSEMENT FEE.
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS. - DATE. INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF I9_ F; NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT - BUILDING OR WORK,
/ SEPTIC TANK,SEEP,PIT(S) - -
ADDRESS AND/OR DRAINFIELD,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS.APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �� CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS. REGULATING ' ALTER,REPAIR,SEWER ORS.
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM Q' �
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 OWNE OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY. ' BACKFILL SEPTIC TANKS ❑
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTE
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VA
LE)ATION ROBERT A.WOOD
M.D, CASH• SUPERVISING MECHANICAL ENGINEER
L' 0 0 0 2 � JUL 2 3 •G A 3 .0 0