HomeMy Public PortalAbout9194 JAYLEE DR_Sewer_9/14/1956_sewer connection 76A642D
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DBSPOSAL
DepDstnient of County Engineer
CiOUIIty Of LOS Angeles
BUIL
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FOR
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WM.J. FOX, COUNTY ENGINEER e �T4�L�
CASSATT D.GRIFFIN,SUPT OF BUILDING ITY
APPLICANT TO FILL IN4 STST.� .
LEGAL �7 s�.�01
N0. 7!/ v
DESCRIPTION LOT -_. OWNER 'rJ �"-
BLOCK TRACT AIL
��y/f� „�y�/ft q DRESS
NO. OF BLDGS. ���++ I
SIZE OF LOT NOW ON LOT CIT TEL. NO.
USE OF ��yy �� -
BUILDINGS All-/`. DISTRICT NO. GROUP AP
BK MP
CONTRACTOR
ADDRESSCONNECTION DATA
CITY EL. NOi '.n 9 ���' STATION _ DEPTH
L` � [[ 'ATE "^�unl F RFPFRr-�r_
IY/'�'
, -/y ,/ UPPER
REGISTRATION NO. O ❑ COUNTY - LOWER
No. I DESCRIPTION OF WORK FEE - ;+
STA /opt/ S� 34.10
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.—TO P.L.
PUBLIC SEWER c(7i $ 3.50 _
HOUSE SEWER CONNECTING TO
PRIVATE-DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. ORP. C. NO.
WORT( TO HOUSE SEWER 1.00 CO. IMP. NO. / V JOB NO.
ALTER OR REPAIR EXISTING i
SEW ER OR DISPOSAL SYSTEM 1.00 TRkfNK PERMIT NO. ROAD PERMIT NO/� J/
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT -
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO,
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00
CHARGES
PERMIT CONNECTION CHARGE FEE J�C��(( ` '�?��6-0OWNER'S 1 00 .d T
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE DATECON-
TRACTORTTOS CONNECTO THEA CTED ABOVEWITH DESCR BED EXISTINGTHE HEREINAMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS _DAY OF
NEW HOUSE SEWER
19
OWNER OR /�� CONNECT ADDITIONAL
OWNERS AGENT�j `�' BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS 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 '
1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND _
CALIFORNIA OR THAT l AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑
SIGNATURE �
SEEP. PIT(S) ❑ CESSPOOLS 0
,/,) 9
OF PERMITTEE j J �l�"0 /qit
.,
WILLIAM J.FOX.COUNTY ENGINEER' VALIDATION R.A.WOOD, C{HIEF7TPLBG. INSPECTOR
o. - _sEP.14 38 3 °7 5 0,&.m
T .. 4Ir p.1 9_3 u, SEP14 4 450 �
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