HomeMy Public PortalAbout9087 LYLEDALE ST_Sewer__ APP
TIOWFOR PERMIT
;S&E•663 12-54 4 �O Y"'9
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER ADDRESS i Y
CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL y �dt/'$'(oN jv"'n
DESCRIPTION' LOT NO. allOWNER
i
BLOCK TRACT ADDRESS
SIZE OF LOT _ N0.OF B GS.
NOW ON OT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTORSO T I
&
ADDRESS `� -Y !ll��� CONNECTION DATA
CITY C. NO�Q /�Qo'J 7 STATION 1+ 0110 DEPTH
/� - ` ❑ STATE p®A A Ate'' MANHOLE REFERENCE
REGISTRATION NO. ry Y C tf Y ❑ COUNTY / (LN txRE� LOWER
TYPE OF CONNECTION LENGTH FROMe
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TOO P.L.
HOUSE SEWER CONNECTING TO R-, yATL
PUBLIC�SEWER tQ $ 3.50 �n--- {r ^ 9
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 ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO,
SEPTIC TANK, SEEPAGE PIT OR
PITS AMD/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT 5 1 00
AUTHORIZATION TOTAL FEE J REIMBURSEMENT FEE
I HAVE THIS DAT CONTRACTED WITH THE HEREIN,NAMED CON-
TRACTOR TO CON ' CT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
.TO THE PUBLIC S ER
SIGNED THIS Y ( 19_ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT•„ BUILDING OR WORK
SEPTIC TANK,.SEEP, PIT(S) !
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLE E THAT I HAVE READ THI APPLICATION CESSPOOL C3 DRYWELL❑
AND STATE THAT THE A E IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDI ANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM -
1HEREBY 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 I AM T E LEGAL OWNER OF THE OVE
DESCRIBED RESIDENT; PROP TY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S).❑ CESSPOOLS❑
SIGNATURE v .
OF PERMITTEE
WILLIAM J. FOX, COUNTY GINEER VALIDATION /je� 11/� In
BT 0 4'Y 0 8 es MAY 25 4
4.
DEPUTY DEPUTY
',By ST
,® DEPUTY DEPUTY