HomeMy Public PortalAbout9157 JAYLEE DR_Sewer_4/23/1954_cesspool YDEPA16g11tENT OF COUNTY ENGdNEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER i� BUILDING
ADDRESS
FOR APPLICANT O FILL I i LOCALITY
BUILDING NEAREST
ADDRESS — CROSS ST.
LOCALITY Q DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA z 9 � S
CROSS ST.
RECEEII.V�EED jBY Ready for Inspection DATEISSUED �L
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS V / I .
BK PG
CITY `^ TEL.NO
CONTRACTOR _
J CO.IMP.N0.
ADDRESS 0' u f iY1 i!Q t �. . /a
_ JOB NO.
CITYQ . 01 TEL.NO. t0
_ �j(� �j - TRUNK PERMIT NO.
REGISTRATION N0. COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. / STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBUCSEWER @ $ 3.50 RECEIPT N0. DATE (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- I DATE f 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
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 DD MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 1 Cdy
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC .SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF........................................I9..._-.- NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT--------------------------------------...-..........................
..........
B U I L D I N G O R W O R K
ADDRESS------%--------------------------
_ SEPTIC TANK,SEEP.PIT(S).
------------------------------------------ AND/O R D RA I N F I E L D
r1
CAI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOORYWELL❑
a
TLION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,R PAIR,SEWER OR V v
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ' AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDE PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
' I SEEP.PIT(S)o CESSPOOLS
OFPERMITTEE-- - ------ ...- :M lti
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