HomeMy Public PortalAbout9157 JAYLEE DR_Sewer_5/3/1957_sewer connection 76A642D . . _ A���p���'9®� .�®� PE EMIT
S&E-663 11.55 -
DIVISION- OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depostnent of County Engineer
County of Los"Angeles # eu�LolNs �y% .7 �! �k - 1)n
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS `�/ y !�
® -CASSATT D. GRIFFIN,-SUP'T OF BUILDING LOCALITY % M Pk C i / N
FOR APPLICANT TO FILL IN ceoss si. ,(o m/a s%
LEGAL �^
"r DESCRIPTION LOT NO. % // OWNER ' •Lb/ '�.g A S "J �FkyI
MAIL
BLOCK - TRACT y (.9 _ ADDRESS
a, e� N0. OF BLDGS. CITY•'` �q i" ( TEL. N0. �'r•�ij'¢
SIZE OF LOT ,'�+'•J,{ i� NOW ON LOT r �t I J>�— ��T �+C
r USE OF oDISTRICT"NO GROUP MAP.
BUILDINGS "I �_ K PG/
s_. CONTRACTOR
tr T eS � P� - _ CONNECTION DATA
ADDRESS
�/5? ':f VA.E5 D(Z
STATION DEPTH-
CITY ""'�=M ,,A' .� TEL. N0. ^0, l3 "—
- MANHOLE REFERENCE /` .�! UPPER
+ ❑ STATE :, tl :P;.ialt7 LOWER
REGISTRATION NO. ❑ COUNTY _
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO /t a TYPE OF CONNECTIO�N LENGTH FROM �7
44
PUBLIC SEWER @ $3.50 l� Y. CURB L. / M.L.TO P.L. Q
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD a $3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELD P.-C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE c+ $2.00 CO. IMP. NO. 1 ('/e JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @. $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1..00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL - -
CHARGES
CONNECTION CHARGE FEE',
OWNER'S PERMIT" $ 1 00 /
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1HAVE 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. .YI NEW HOUSE SEWER _
SIGNED THIS DAY OF .� a� '
!J c I9 �' CONNECT ADDITIONAL
OWNER OR BUILDING OR WORKG�
OWNERS AGENT � / �/"^�} '•'� TANK,SEPTIC PIT(S)
- -
_ADDRESS /y �/qV A.f=(Z, AQ. ?'• � AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR Q DISCONNECT PLUG AND
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 RESIDENTIAL PROPERTY. �. BACKFILL SEPTIC TANKS❑ ,^.Pl, f?r
f
SIGNATURE - SEEP. PIT(S) ElCESSPOOLS nm's'9
�f �Z4 � a _
OF PERMITTEE T
sf67'✓L�/J
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. m. 0. ASH - -
tACO7 8 M 3. 4 4.50