HomeMy Public PortalAbout9194 JAYLEE DR_Sewer_9/14/1956_tap and saddle 9&E-663 11-55 A u PU C A TM D V F®Il 11 PERMIT .�
DIVISIONOF BUILDING AND SAFETY SEWER-SEWAGE ®9SP®SAL
Deportment of County Engineer "'
County of Los Angeles BUILDING �L
JOHN A. LAMBIE, COUNTY.ENGINEER ADDRESS
® - CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
r
- NEAREST - '
FOR 'A�PPLIC�ANT TO F;LL IN, ^` CROSS ST.
LEGAL '/y '���� ^� OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT �8., �L r�4 �(.FC��£6!! �� ADDRESS o
ANO. OF BLDGS. 1
.SIZE OF LOT » 00—NOW ON LOT CIT L. NO.D(�
USE OF - ,��,�p DISTRICT N� G UP MAP
BK BUILDINGS 'lJl/��
PG
CONTRACTOR a, CEJ
J ADDRESS CONNECTION DATA
n ® � STATION DEPTH
CITY TEL. NO. Q
pCE \II/ .I
STATE
REGISTRATION NO. / �(�/ ® ❑� COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER '@ $3.50 Y. CURB - P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR "
PITS AND/OR DRAINFIELD n $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD i P. C: NO.
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. NO. � Q JOB NO.
HOUSE SEWER CONNECTING TO l0
PRIVATE DISPOSAL SYSTEM @ $L00 - TRUNK PERMIT NO. ROAD PERMIT N0.-!
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $I.00 PERMIT NO.-
ALTER,REPAIR OR ABANDON HOUSE ' INDUSTRIAL- -
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVALP— 00 CHARGES
CONNECTION CHARGE FEE
OWNER'S E�€ I+�3� a fP/'0� °t'/� TAY /zAd/fb
REIMBURSEMENT FEE '
AUTHORIZATION TOTAL FEE P,
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CDN- APPROVALS / DATE INSPECTORS SIGNATURE .
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.. - NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL `o ''��,,tf �J
OWNER OR _ - BUILDING OR WORK -
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS v AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I 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 -
'1 HEREBY 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 RESIDENTIAL PROPERTY. 0%'�=G%% / BAC ❑ [IKFILL SEPTIC TANKS❑
_SEEP.PIT(S) CESSPOOLS '
s SIGNATURE � 0e
� OF PERMITTEEI3:�j
Y R
JOHN A. LAMBIE..COUNTY ENGINEER VALIDATION - ROBERT A.W OD, CHIEF PLBG. INSPECTOR
CK, M.0. CASH
a0 l 9 -- sEP1� 5 2.5,4 �.