HomeMy Public PortalAbout9168 JAYLEE DR_Sewer_9/2/1955_sewer connection �- - PERMIT
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DIVISION-OF BUILDING ARID SAFETY SEWER-SEWAGE .DISPOSAL
Deportment of County Engineer j
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS 5
' CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY - -
FOR APPLICANT TO FILL IN CROSS sT. 7 t -f
LEGAL -
_DESCRIPTION LOT NO. 0 f i,fi
BLOCK TRACT I 7 "7 AIL
ADDRESS
NO. OF BLDGS. -
SIZE OF LOT NOW ON LOT TY(„ T L �.i.
USE OF
BUILDINGS - = LC- I� s-�i...�'..t
`DIST CT NO. GROUP MAP
,r✓C� I I BK PG��
CONTRACTOR �
ADDRESS a/� CONNECTION DATA
CITY TEL. NO. STATION DEPTH
QjL TATE MANHOLE REFERENCE
REGISTRATION NO. /` s� ❑ COUNTY `13{ E'f? �/ �,GsCL- OWER
TYPE OF CONNECTI N—, LENG FROM 7V/
NO. DESCRIPTION OF WORK FEE Y. CURB 7P.Lj M.L.TO P.L. 1'
HOUSE SEWER CONNECTING T0.
PUBLIC SEWER @ $ 3.50c�_
HOUSE'SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP.N0. b' JOB. NO.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N .
DISCONNECT AND ABANDON SEWER• STATE ENCROACHMENT
-AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR D_RAINFIELD 2.00. INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHA S
PERMIT CONNECTION CHARGE FEE /6r
Ovjm'$ $ 1 00
AUTHORIZATION TOTAL FEE Ku REIMBURSEMENT FEE
I HAVE"THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DE BED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SE ER
OUSE SEWER
SIGNED THIS Y 0 19 uu
OWNER' OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS' SEPTIC SEPTIC TANK, SEEP,PIT(S)
AND/OR DRAINFIELD
1 HERE ACKNOWLEDGE AT I�H E REA THIS APPLICATION CESSPOOL❑ D_RYWELL(3AND STATE THAT THE A E IS COR ECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES/A D STATE LAWS REGULATING ALTER, REPAIR,SEWER OR -
PLUMBING AND SEWERS. f _SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AMWPROPERLY REGISTERED AND/OR D
DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER �x��
CALIFORNIA OR THAT 1 A THE LEGAL OWNER OF THE ABOVEA�'�''C,�"
DESCRIBED RESIDENiI El
P PERTY. BACKFILL SEPTIC TANKS p
SEEP. PITS) [ICESSPOOLS 18-,� a
SIGNATURE •I - -
OF PERMITTE - -
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY - h 7. 4 9 7 "SEP 2 4 45
DEPUTY DEPUTY
BY BY
'•® DEPUTY DEPUTY