HomeMy Public PortalAbout9034 JAYLEE DR_Sewer_1/20/1958_sewer connection S&E-466311.55 APPLICATION FOR MERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ?o -t
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST
LEGALn
DESCRIPTION LOT O. OWNER LL 6
-MAIL �7 /7
BLOCK T � _ADDRESS a/
NO, OF BLDGS. CITY N0. 1>
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK
CONTRACTOR ,-,Li u �, (L C, K;' �]f-/� ?IG
CONNECTION DATA
ADDRESS n �Q � � z y� L
CITY �Clst.t �T�1. NO. l STATION�"�-C> c%s �. DEPTH 6
_ MANHOLE REFERENCE U
❑ STATE OWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
Z) ECTIO ---
HOUSE SEWER CONNECTING TO TYPE OF CONNN LENGTH FROM
Y. CURB 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.,CESSPOOL,DRYWE LL,M AN HOLE @ $2.00 CO. IMP. NO. 'C/ JOB NO.
I HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 _TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STAC 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
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER i" 3•'
SIGNED THIS DAY OF 19
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT 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
I HEREBY CERTIFY THAT 1 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. BACKFILL SEPTIC TANKS❑ ..
p/�,
SEEP._PIT(S) ❑ CESSPOOLS 5i,
SIGNATURE
OF PERMITTEE .ti�L-
JOHN A. LAMBIE, COUNTY EN INFER - ' ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
N.O. GASH
1 0 5 3 8 il JAN 20 4 A 4.5 '� °'