HomeMy Public PortalAbout9134 1/2 RANCHO REAL RD_Sewer_3/16/1953 DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
BK PG
CITY TEL.NO.
CONTRACTOR
CO.IMP.NO.
ADDRESS
-- ,. JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO. '-
REGISTRATION N0. ❑ STATE
❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL — --
SIZE OF LOT NO.OF SLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ; 3.50 RECEIPT N0. I DATE I BY
HOUSE SEWER CONNECTING TO i
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.QR EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE (BY
SEWER OR DISPOSAL SYSTEM 1.00 i
DISCONNECT AND ABANDbN SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—ORYW£LL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
i UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; i OD
Y. -. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I —
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF-..-.. .....................-..e......19......_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT....:.. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS...... - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- 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
1 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE I SEEP.PIT(S)o CESSPOOLSI�
OF PERMITTEE...--------------- - •..._.....
..._._..:... -
76A642D 6G3 1/53