HomeMy Public PortalAbout9167 JAYLEE DR_Sewer_10/30/1956_sewer connection 9 a E•6E-663 9.55 D
9 A P LI-C A T I®1�1 C1 FOR PERMIT ap�J
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL s�
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX.COUNTY ENGINEER ADDRESS �rrL
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN ceoss sr.
LEGAL
DESCRIPTION LOT NO. OWNER /,r Com'- ¢i• 'd''��_.
BLOCK TRACT - _ MAIL
ADDRESS �}
N0. OF BLDGS.
SIZE OF OF LOT NOW ON LOT CITY TEL. NO.0' I USE OF
BUILDINGS- (.. s`f�"' 7 % i DISTRICT NO. GGRyOOUPP �{ MAP
SK PG
CONT - (�/ Y ,
J
/AD E s GZ Gam' / CONNECTION DATA
(„STEL. NO'I/-y 5r ,, STATION .f j DEPTH
❑ STATE MANHOLE REFERENCEf� 1 UPPER
REGISTRA ION NO. ❑ COUNTY �1: - "` LOWER
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECT — LENGTH FROM •�
HOUSE SEWER.CONNECTING TO Y.
CURB P.
M.L. TO P.L.
PUBLIC SEWER @ $ 3.50 �'•
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM -1.00 -
CONNECT ADDITIONAL BLDG. OR o1 P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. N0. /.�7P JOB NO.
ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER OR.DISPOSAL SYSTEM' 7.00 _
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT _
AND/OR DISPOSAL-SYSTEM 1.00 _ PERMIT NO.
SEPTIC TANK,SEEPAGE'PIT OR
PITS AND/OR DRAINFIELD .9.0 INDUSTRIAL ,
CESSPOOL-DRYWELL 'WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
' CONNECTION CHARGE FEE -
OWNER'S PERMIT " 5 t ' 00
AUTHORIZATION TOTAL FEE J REIMBURSEMENT FEE
I HAVE THIS-DATE CONTRACTED WITH THE HEREI NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EX ING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PESCRIUBLIC SELL rr [/f�
SIGNED THIS DAY OF �� a NEW HOUSE SEWER 1 J? Me 14A �.6
^� CONNECT ADDITIONAL r.
OWNER OR- � ,�' BUILDING OR WORK
OWNERS AGTit
L SEPTIC TANK, SEEP, PIT(S)
ADDRESS _ —^^® AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE HAT HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL(] --
AND STATE THAT THE AB E IS ORRECT AND AGREE TO COMPLY
WITH ALL COUNTY 0 NANC AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR;SEWER OR
SEWAGE DISPOSAL SYSTEM -
I HEREBY CERTIFY THAT 1 AM PROPERLY, REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELE C UNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA--DR THAT I AM THE LEG NER OF THE ABOVE ABANDON HOUSE SEWER 7y�p � ^� , g�
DES CRIB F/�SI, N RT�.
SEEP.BACKFPIT(SEP❑CC SSPOO S . � �u;t�V d,R/( -
SIG A EWf,/' cf '
I OF P M -
f WI IAM J.FOX.COUNTY EN NEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
.s.6.9Ln oc�3 4..50