HomeMy Public PortalAbout9073-9075-9077 LYLEDALE ST_Sewer__ DEPARTHIENT OF COUNTY FNGIN`F.ER SEVER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS A_r7GELES
WILLIAM J. FOX, COUNTY ENGINEER I AUILDING
DDRESS
NEAREST
APPLICANT TO FILL IN LOCALITYBUILDING
ADDRESS /d73� yam-- CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT N0,
NEAREST
ID A /� f-9- ? S
CROSS ST. RECEIVED BY Ready for Inspection DATEISSUED
OWNER 61
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MAIL USE ZONE OCCUPANCY MAP
ADDRESS X7UO ��� , BK PG
CITYA. TEL•.NO.
CONTRACTOR y
CO.IMP.N0.
ADDRESS amCo. 0 emp e i y /-7 6
JOB.N0. / a9
CITY TEMPLE N TRUNK PERMIT NO.
Q g STATE
REGISTRATION NO. �(/` COUNTY ROAD PERMIT NO.
LEGAL0 7 STATE ENCROACHMENT
DESCRIPTION LOT N0. _ PERMIT N0.
BLOCK TRACT 'o WASTE APPROVAL
SIZE OF LOT NO LOTS CHARGES k
USE OF BUILDINGS CONNECTION CHARGE FEE
NO. DESCRI ION OF WORK FEE \� `
HOUSE SEWUR CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 5t) RECEIPT NO. (\/DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIONRECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I' DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND
_ AND/OR DISPOSAL SYSTEMN SEWER 1,00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR 0
PITS AND/OR DRAINFIELD 2.00 STATION ! DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 *7/ E- MANUHOLE PPER REFERENCE L
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 _y_ cm P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I _"�'o -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO T E P BLIC SEWER a ^
SIGNED THIS__ •_ • NEW HOUSE SEWER
ovmte _ CONNECT ADDITIONAL
OWNR—AGEN __ w r. � / *� BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDR _.._� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE�THAT 1 HAVE READ THS APPA- CESSPOOL[-] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE-SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESC IB SID NTIAL PROPERTY. BACKFILL SEPTIC TANKS
7 dot—SIGNATURE C SEEP.PIT(S)C] CESSPOOLS
OF PERMITTEE-._ ___ _ _ _ ____-__
76A642A 663 7/53