HomeMy Public PortalAbout9018 RANCHO REAL RD_Sewer_6/22/1954_28102S DEPARTNEMW OF COUNTY ENGnvEEn SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION-
COUNTY OF LOS ANGELES Jf BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
LOCALITY
FOR APPLICANT•TO FILL IN `�� �•
BUILDING Fl,
i/ NEAREST �+ � ,y /� /� /
ADDRESS G9I. � i��D �f I-1- CROSS ST. D�1 /i/I/1 /�1-/J .0 �(J. ;.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY �/�- y� �.
NEAREST j A S
CROSS ST.
? QRECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
dr Sr.l ``L=�s4°�/: d/ r/ll�Lt/ �, r• �t •'s
ADDRESS' I/f� j � ''� jJ � = USE ZONE OCCUPANCY BK MAP
CITY ,C�!!"�.�1'/ --� TEL.NO. I..
CONTRACTOR CO.IMP.P10. i
ADDRESS JOB NO.
CITY s THL.NO. j� 2 /,_ �. ..� -.._.
��•� Ivim./�i'� `_.►"�+'�,� 4NK PERMIT N0. •�" .,
V /T Z� 1 BtSTATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT NO. J PERMIT NO.
BLOCK TRACT t ° INDUSTRIAL
., WASTE APPROVAL
SIZE OF LOT -7 �r .i N0.OF BLDGS.
X 17� NOW ON LOT - = CHARGE
USE OF ,,a �, CONNECTION CHARGE F
NGS
BUILDIfi 1 �/�",t
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC.SEWER a $ S.50 r RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR _ EXCEPTION R CORDED
WORK TO HOUSE SEWER_ 1.00
ALTER OR-REPAIR EXISTING NO. I DAT lay SEWER OR DISPOSAL SYSTEM - 1.00 f
DI 0 'NEGT-ANBAN00 8E R
_ /o�R�DISIPosAL ars�EM � CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR ORA,NFIELO 2.00STATION . " y am DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 l '' ANHOLE REFERENCE
/ E.4 OWER ..
TYPE OF C0 NECTIO LENGTH FROM
OWNERS PERMIT $ I 00 GUJi& P.Lh M.L.TO P.L.
AUTHORIZATION -: TOTAL FEE
1 HAVE THIS DATECONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE,DESCRIBED EXISTING, APPROVALS INSPECTOR' -SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
Q� `� Y NEW.HOUSE SEWER
SIGNED THIS__._.•..._._.DAY O,F_:_�__.:. :1: _.__.19 r::l ✓/,ii...�x so A2
OWNER OR/ .� fj✓,%, •+ CONNECT ADDITIONAL
OWNERS AGENT_`..:::. r'�+� ^" r y+ BUILDINGORWORK
ADDRESS__ �� +S� -'• -.fir'• .�, SEPTIC TANK,SEEP.PIT(S)
r.._.... - -...�=' - -==`==:=y.. y-••--•- AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT.1 HAVE READ THIS APPLI CESSPOOL❑ DRYW.ELL
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 1 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 0-SCRIBE RESIDEN IA ROPERTY. BACKFILL SEPTIC TANKS(]
SIGNATURE �' _Z� _ - SEEP.PIT(S)o CESSPOOL-&e.
TE
OF PERMIT _..._..�.__.__�:t.___...�_ _. ..._......_._
76A642A 663 7/53