HomeMy Public PortalAbout9185 JAYLEE DR_Sewer_7/12/1955_sewer connection 76A6420 TION ::.FO R PERMIT
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DIVISION='OF BUIL ,14G, AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County�£ngineer
County of Los Angelos BUILDING
WM. J. FOX, COUNTY EN _'NEER ADDRESS.
' CASSATT 10. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. 1.y
LEGAL J
DESCRIPTION _ LOT NO. /. OWNER
BLOCK TRACT" MAIL
- ADDRESS
C)N0. OF BLDGS.
SIZE OF LOT LrNO ON LOT CITY TEL. N0.
USOF
BUILDINGS DISTRICT N0, GROUP MAP
- -r'4 .EK PG
CONTRACTOR +.
ADDRESS v CONNECTION DATA /
CITY L, NO.. STATION � q0 f 7, .1� DEPTH , �
1. ❑ STATE i ) t'ANHO LE REFERENCE k�
REGISTRATION NO. / -fl�..�- COUNTY -it-a.
' .�v �'�' OTs"' UPPER
❑ �
r 1 TYPE OF CONNEC _ LENGTH FROM «�r
NO. DESCRIPTION OF WORK FEE Y, CURB P.L•' M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $ 3.50 „� v
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
y' CONNECT ADDITIONAL BLDG. OR 9 O CO. IMP. NO. ` �J O f JOB. NO.
/. WORK TO HOUSE SEWER .1.00
ALTER OR REPAIR EXISTING -
_
-SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND-ABANDON SEWER STATE ENCROACHMENT _
AND/OR DISPOSAL SYSTEM 1.00 __ PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR r
_ PITS AND/OR DRAINFIEL-D 2.00 INDUSTRIAL
CESSPOOL- DRYWELL - WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 - CHA'RGES
CONNECTION CHAPE' EF E
OWNERS PERMIT S 1 00
AUTHORIZATION - TOTAL FEE' G' ' REIMBURS ENT FEE
IHAVE 'CON-
TRACTOR TOS D ATE;CONNECTO THE ABODWITH. THE VE DESCRIBED EXISNINGA DWELLING APPROVALS DATE `INSPECTOR'S SIGNATURE
TO THE PUBLI.0•SEWER - f_
NEW HOUSE SEWER
SIGNED THIS DW OF 19 1 1111""TT VV sex IIJCCCd,
-OWNER OR - CONNECT ADDITIONAL
OWNERS.,,. AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY'ACKNOW E E THAT I HAVE REID THIS APPLC TION CESSPOOL❑ DRYWELL❑ -
AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO hIPLY
WITH ALL -COUNTY ORDINANCES AND STATE LAWS REGULATING, -ALTER, REPAIR,SEWER OR, -
PLUMBING,AND SEWERS. SEWAGE DISPOSAL SYSTEM '
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES- COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT AM' THE- LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER - -
DESCRIBED RESID AL ROPERTY, BACKFILL SEPTIC-TANKS❑
SEEP.PIT(S) ❑ CESSPOOLS fl(1
SIGNATURE / vIl
OF PERMITTEE 4�C -
+w`
WILLIAM J. FOX,COUNTY ENGINEER VAIMATIOIIT
5 5 .4 � JUL f�
BY F a �" 12 4 5:5 0 tr,
,.,.,,. r BY
DEPUTY DEPUTY
BY c BY
DEPUTY DEPUTY