HomeMy Public PortalAbout9162 JAYLEE DR_Sewer_8/5/1957_sewer connection S&E669 1.1-55
-DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
... Depcatment of County Engineer
County of Los Angeles BUILDING
JOHN•A. LAMBIE, COUNTY ENGINEER ADDRESS' f'
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL d)' �
DESCRIPTION LOT NO. yz. - OWNER �. s
9 4 MAIL
BLOCK TRACT `l' ADDRESS
NO.OF BLDGS. C
SIZE OF LOT NOW ON LOT CITY TEL. NO '
°
USE
OF ( - DISTRICT NO. - GROUP MAP
` BUILDINGS BK PG
CONTRACTOR /
CONNECTION DATA
ADDRESS
'�'�'° ! j STATION DEPTH
CITY - TEL. NO. /
7 MANHOLE REFERENCE '/ q UPPER ,
STATE �� 1�1 = `L'
REGISTRATION NO, ,� > ❑ COUNTY _
NO. "DESCRIPTION OF WORK FEE TYPE OF CONNECTION,� LENGTH FROM J
HOUSE SEWER CONNECTING TO 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,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. (? / JOB NO.
X 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 PERMITg 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 1.4 >
1 HAVE AT THIS DATE-A CONTRACT WITH THE-HEREIN NAMED CON- - APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - - xry— 7 y� A
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19-!Sy 3 CONNECT ADDITIONAL
OWNER ORs _ BUILDING OR WORK '
< OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION s,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ CESSPOOL❑ DRYWELL❑
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 REGIST D AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES UNT ND STATE OF ABANDON HOUSE SEWER .
CALIFORNIA OR THAT I THE LEG OF H ABOV
DESCRIBED RESIDENTI ROPERTY. BACKFILL SEPTIC TANKS❑
s SIGNATURE SEEP.PIT(S) ❑ CESS POOLS �� ••�� �;!(�y,'
OF PERMITTEE10� t�
JOHN A. LAMBIE."CO�XKEI<GINEER0ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
0. CASH -
0947 AUG 5 4 45" : �: