HomeMy Public PortalAbout9019 RANCHO REAL RD_Sewer_4/21/1953_6768S 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
CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS
FOR APPLICA.,NT TO FILL LOCALITY
BUILDING
ADDRESS �' f f {L0 / NEAREST
GROSS ST.
LOCALITY '` DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
GROSS ST
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADORES�S BK PG
CITY !e-7e6C TELAO.
CONTRACTOR - _ CHARGES REIMBURSEMENT FEE
ADDRESS �`� " `a ' ' ' - REQUIRED
NOT REQUIRED
CITY TEL.NO. CONNECTION CHARGE FEE
-- - -
REGISTRATION N0. d c!✓ 8TC9U1i7Y JOB.NO.CO.IMP,N0.
LEGAL } RECEIPT NO. I DATE BY
DESCRIPTION LOT NO. f
BLOCK � TRACT ,j' WAIVER FOR RECORDING
SIZE OF LOOT&/i f�#A1 y «� NO.OF BLDGS.
r J NOW ON LOT RECEIPT NO. 1 DATE BY
USE OF
BUILDINGS p� "�jT t"
TRUNK PERMIT N0. --
N0. DESCRIPTION OF WORK. FEE
HOUSE SEW€R CONNECTING TO ROAD PERMIT NO.
PUBLIC SEWER_ @ $ 3.50 _
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT ---_-
PRIVATE DISPOSAL.SYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER____ 1.00 WASTE APPROVAL -
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER I
AND/OR DISPOSAL SYSTEM 1.00 STATION DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL , { UPPER LOWER.
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION LENGTH FROM
hY. - CURB P.L. M.L.TO P.L.
OWNERS _PERMIT_ 1 00_ --
AUTHORIZATION TOTAL FEE --
1 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
I'
SIGNED THIS------- ,:...-.DAY OF ..............19--------- NEW HOUSE SEWER
OWNER OR t7�' In,
](i CONNECT ADDITIONAL
OWNERS AGENT ....................... BUILDING OR WORK _I
.____._._...------------------------................. SEPTIC TANK,SEEP.PIT(S)
ADDRESS...
-------------------------------------- AND/OR DRAINFIELD
t HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL G1 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE —
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE PESCRIBED RFSfDENTJAL PROPERTY. BACKFILL SEPTIC TANKS I]
� � SEEP.PIT(S)E] CESSPOOLS(3
SIGNATURE t(
OF PERMITTEE--- ---•! -.. .-��:• �..iL'i-._-.- ...--.-•-.-----
7GA64'2D 663 12/52• �'