HomeMy Public PortalAbout9189 JAYLEE DR_Sewer_10/10/1955_sewer connection ,qpm ®® '+qp_[��p ��q�g pin+ p@�� PERMIT 'IPS[pppp,,,pppq.��gl \
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D 0 S pOSA L
Deportment of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY �� ���r�
FOR APPLICANT TO FILL IN NEAREST `���-�
s-� CROSS ST. -
D SE RAPTION LOT NO. �J OWNER
BLOCK TRACT / aMAIL
NO.OF BL GS• ADDRESS _ :zft�
SIZE OF LOT �_ NOW ON LOT CITY .TEL. N0.
USE OF - - -
_ BUILDINGS ) �/���i DISTRICT O. GROUP MAP
SK PG
CONTRACTOR ! ���(.�i .I - _ oy
ADDRFs.��,�� �;� / CONNECTION DATA
CITY � ���� TEL. N �� �i STATION- �' � DEPTH f! -
e6� 6-STATE �'' 0 'I, MANHOLE REFERENCE
A
REGISTRATION NO. _ ,y��j ❑ COUNTY �.7'.J� ' UPPER LDk*M
v •✓ - - TYPE OF CONNECTION LENGTH FROM e
No: DESCRIPTION OF WORK FEE Y? -c-U;Rn P.L. M.L.TO P.L.
�y HOUSE SEWER CONNECTING TO -
f� 'PU BLIC SEWER ' n' $ .,3:50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM - 1.00
CONNECT ADDITIONAL BLDG. OR - CO. IMP. NO. JOB. N0.
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 EN
AND/OR DISPOSAL SYSTEM 1.00 ROACHMENT
PERMIT NCC
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 - v CHARGES
OMERIS PERMIT $
CONNECTION CHARGE FEE
1 00
AUTHORIZATION TOTAL FEE � J REIMBURSEMENT FEE
I HAVE TRACTOR TOSCONNEC DATE TTHEACTED WITH-THE ABOVE DESCRIBED EXISTINGMED DWELL G APPROVALS DATE INSPECTOR'S SIGNATURE.
TO THE PUBLIC SE -R - _
NEW HOUSE.SEWER
SIGNED THIS AY OF 19 �0�3 3�OWNER 'OR OR Jl CONNECT ADDITIONAL
OWNERS NTw�► /t` BUILDING OR WORK
EPTIC--ADDRESS-In`��//'ril!l�,�/ 4� pAND/ORTDRAINFEELDPIT(S) .'
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 ep
AM THE LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL .
BACKFILL SEPTTC'T`A'N'KS❑
BACKFILL
-CESSPOOLS 0-7�7-.s_
SIGNATURE '
OF PERMITTEE -
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION
BY . Co 8 7 87Y 2'UP-) GCT 10 4 4.5 0 E'
DEPUTY - DEPUTY
.By - BY
�® DEPUTY _ C DEPUTY .-