HomeMy Public PortalAbout9179 JAYLEE DR_Sewer_1/30/1957_sewer connection /� 1 , Ipq� I� �/�
CATION
S&E•663 11.55 �
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE .DISPOSAL
Department of County Engineer < ` ;
County of Los Angeles BUILDING CA q
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SU_P'T OF BUILDING B LOCALITY' -
-. FOR APPLICANT TO FILL IN caoss sz. -
LEGAL
DESCRIPTION. LOT NO. OWNER ''•��' '
. IV7"+ MAIL $"
BLOCK TRACT ADDRESS; R
NO. OF BLDGS.
SIZE OF LOT - NOW ON LOT CITY ` TE
USE OF. 4D DS
BUILDINGS DISTRICT GROUP MAP
BK PG
CONTRACTOR
ADDRESS'A/_ - - CONNECTION DATA
STATION - )4-11
DEPTH
CITY. O. -
MANHOLE REFERENCE UPPER
C3 STATE LOWER
REGISTRATION N El COUNTYv / z
� /�• �,/
NO. DESCRIPTION OF W K V FEE
�. HO.USE.SEWER CONNECTING TO TYPE OF CONNECTION. LENGTH FROM
Y. -. - CURB., _ ..P.L.-.._ -M.L.TO..P.L...-- ------' - -----
PUBLIC SEWER - - - - @ --$3.50 - - - _ ---
SEPTIC TANK,SEEPAGE PIT OR '
PITS'AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT_DRAINFIELD P. C. NO ,
EXTN.,C ESS PO.O L,DRYW E LL,M A N H O LE @ ,$2.00 • CO. IMP. N0. ���..��- 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
'.'. REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE ®C:
I HAVE,AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR.'SSIGNATURE ,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE .PUBLIC SEWER. t��-g NEW HOUSE SEWER _
SIGNED THIS { Y OF 19-J I CONNECT ADDITIONAL ,
OWNER OR' BUILDING OR WORK
'. OWNERS-AGE ry n.
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLED THA HAVE READ IS APPLIC TION I.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO PLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM -
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '^ -
CALIFORNIA OR THAT I AM THE LEGAL ER. OF THE ABOVE o- ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PERTY,. BACKFILL SEPTIC TANKS❑
SIGNATURE T SEEP.PIT(S) [:] CESSPOOLS❑
OF PERMITTEE
JOHN A.LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.Q. AASH-)-
f C - 6 o '51 AR30 4 >.00 ' �