HomeMy Public PortalAbout9179 JAYLEE DR_Sewer_7/5/1955_sewer connection rr�yv�! Nq�(p�� q��p ..�@p� ® pppgq���
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DIVISION OF BUILDING AND SAFETYSEWER-SEWAGE 0S ®SAL
Department of County Engineer
County of Los Angeles BUILDING �R_
WM. J. FOX. COUNTY ENGINEER ADDRESS 9 y
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR,APPLICANT TO FILL.IN NEAREST �.
CROSS ST.
LEGAL
DESCRIPTION ` 'LOT NO. OWNER
BLOCK TRACT MAIL - '
p ADDRESS
NO OF SIZE OF LOT ` /��/ 'v NOW ONBLOT LD S
CITY TEL. NO.
USE OF
BUILDINGS A�i DISTRICT NO. GROUP MAP
Ola' a tea' f? I B K� PG
CONTRACTOR 4 -
ADDRES , �, CONNECTION DATA
CIT _ TEL. NO. �7 2,. 1) STATION7T- //. d DEPTH
REGISTRATION NO. X S 1 L.�.4.�\ 1�f ❑ COUNTY ���,A [J 4 UPPER NHOLE REFERENCE
Itll l �-_+ LLL CEJ .TYPE OF CONN TIgg��+-- LENGTH FROM
NO. DESCRIPTION OF WORK- FEE Y• CURB. /P.Ctij M.L.TO P.L.
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER..., _ _ Q. $. 3.50
�- HOUSE SEWER CONNECTING TO
PRIVATE.DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR '�
CO. IMP. NO. JOB. NO.
WORK TO HOUSE SEWER 1.00 _
,ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 •TRUNK PERMIT NO. ROAD PERMIT NO.
. DISCONNECT AND ABANDON SEWER - STATE ENCROACHMENT -
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
__PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL '
CESSPOOL- DRYWELL. WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION TOTAL FEE m REIMBURSEMENT FEE
I HAVE THIS DATE .CONTRACTED WITH THE HEREIN NAMED CON- _
TRACTOR TO CONNECT T_HF ,BOVE DESC 16ED EXISTING DWELLING - APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW f2'�°°�
NEW HOUSE SEWER �� !
SIGNED THIS DAY'OF 19 �— mtA�J °
OWNER OR kC� CONNECT ADDITIONAL
OWNERS AGENT
�j ,i�1Qipp�� .93- BUILDING OR WORK
_ADDRESS ` r a. •h,..EAt�t_ ?..-+ ;� �� 0 SEPTIC TANK, SEEP, PIT(S)
`` AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT l "HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,�REPAIR,SEWER OR
PLUMBING AND SEWERS., SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR 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 R. ENTIAL PROPERTY.1 BACKFILL SEPTIC TANKS[] \,{,
�_ SEEP:RIT(S) ❑ CESSPOOLS I$(
SIGNATURE
`gW'�e;�
OF PERMI T E ��E�r A A-
—'
e. /
WILLIAM J. FO OUNTY ENGI�tE�R VALIDATION
5 t3'4 4 NRA -Ja 5A 4.15 0 r)
BY BY
DEPUTY DEPUTY
BY BY
® DEPUTY DEPUTY