HomeMy Public PortalAbout9026 JAYLEE DR_Sewer_1/27/1954_cesspool DEPARTMENT OF COUNTY ENGLYEER SEWER—SEWAGE DOSPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION!
COUNTY OF tNE I BUILDING ®� L a
WILLIAM J. FOX., COUNTY
ENGINEER
9 CP
ADDRESS P
FOR APPLICANT TO FILL IN LOCALITY
BUILDING / NEAREST
ADDRESS Q CROSS ST. L,y lyy't .
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. C
NEAREST `�
CROSS ST.
�/ R CEIVED BY Ready for Inspection \ DATE II�SSUED
OWNER ` dl/.Ire� C��mt�� 1 ZA.O -J
MAIL USE ZONE' OCCUPANCY MAP
ADDRESS I � I BK PG
CITY TEL.NO. 0 1
CONTRACTOR S® „ t T. �.,t n�i�, CO.IMP.NO.
�BYY{{-rr$�FeftTi o. of LR7TFi•T>^G-.
ADDRESS )5931 Isf—nVERi v duc JOB.N0.
CITY X'FMPLiM19% CALIF. TRUNK PERMIT NO.
STATE
REGISTRATION NO. ® COUNTY ROAD PERMIT NO. -
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE'APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USE
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER r@ ; 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
.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
SPECIAL CONDITIONS ONLY lGft�nFa�2.00 11cfi'
MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 Y CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE 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...............-......_-_____-....................................................... AND/OR DRAINFIELD
CAT ONRAND STATE THAT THE ABOVE SVCORRECTTAND AGREE HIS APPLI� CESSPOOLS DRYWELL
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ,.ABANDON HOUSE-SEWER
AND
AND STATE OF CALIFORNIA OR THAT 1 AM THEEGAL OWN•
ER OF THE ABO�({s Q{oSgR1f, � IPERTY. BACKFILL SEPTIC TANKS
SIGNATURE — !� (tlV 1 s SEEP.PIT(S)E] CESSPOOLS E]
OF PERMITTEE o � __. `.•--------------— ---a
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76A642A 663 7/53