HomeMy Public PortalAbout9086 LYLEDALE ST_Sewer__ crsos-a-sa COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ;
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
,.. ,,. NEAREST
FOR APPLICANT TO FILL INCROSS ST.
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LEAL
DESCRIPTION LOT NO `L E.e D F� 4�0'9 aAIL
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BLOCK( �
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NO
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CITY
USE OF
BUILDINGS lt6• DISTRICT NO.: GROUP V BK F MAP a PG PROt4SSED BY
'r CONTRACTOR
ADDRESS —7 1(6— `f
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REGISTRATION NO�p �d Cv� lam' +?
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CAPPLICATION FPERMIT
esos-e-ss COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER ..
BUILDING AND SAFETY DIVISION BUILDING i?P�4 z74
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt'of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEAL \ �� 1
DESCRIPTION LOT NO. ��r (��Y" �5�' OWNER
BLOCK ' TRACT MAI L
ADDR
SIZE OF LOT� TO.OF BLDG$. \
� OW On LOT
USE OF
BUILDINGSDISTRICT N0. GR Pi KPROCESSED BY
u CONTRACTOR J- PG
ADDRESS � —W S`�.LL Cl ( `•[/-/ COILV//NNECTION DATA
CITY erg P ( /STEL.NO.
T >�{ `� STATION DEPTH
REGISTRATION N0. (ti}t f2 9G Y STATE MANHOLE REFERENC UPPER
COUNTY LOWER
' No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TOC.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. B NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROA PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACH NT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APP AL
CHARGES
n
OWT&Ws $ CONNECTION CHARGE FEE
AUTHORIZATIONL—=EOTALFEE REIZU4EE D o
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTS yah BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADD >�' t AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL tOWNER OF THE-ABOVE
DESCRIBED RESLIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
E]SIGNATURE _ � lt;� r SEEP.PIT(S) CESSPOOLS
OF PERMITII EEF ,
®P VALIDiTION ROBERT A.WOOD
PERXISINFi MECHANICAL ENGINEER
U,Co 2 4 6 0 n SEP 8 1 A 1 59-00