HomeMy Public PortalAbout9020-9022-9022 1/2-9024-9026-9028 RANCHO REAL RD_Sewer_1975-08-15 CE8" - 9/73
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APPLICATION FOR PRMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS DDRESS
4-4
LOCALITY
N NE
EAREST
..0..
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO, OWNER
MAIL
BLOCK TRACT ADDRESS'
NO. OF VBLDGS,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF I
BUILDING" DISTRICTNo' "Roup MAP PPROCESSED BY
A
CONTRACTOR _- l
SK
ADDRESS
CONNECTION DATA
STATIONDEPTH
CITY EL. NO 1 &17 1. 4
STATEIC MANHOLERE
SE NO, L0 FERENCE UPPER
LOWER
LICENSE LASS /
�NO. DESCRIPTION OF WORK FEE `TYPE OF CONNECTION LENGTH FROM -
HOUSE SEWER CONNECTING TO Y. CURB P,L. M.L.TO P.L.
PUBLIC SEWER $7.00
P.C.
SEPTIC DANK,SEEPAGE PIT OR
O.
�
PITS AND/OR DRAINFIELD @ $10.00 IMP.NO, NO-
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN CESSPOOL.DRYWELL. $5.00— HWY,OR ST.WIDENING CJ1
ALTER.REPAIR OR ABANDON HOUSE
0
tSEW ER FIR DISPOSAL SYSTEM 0 $3�00 CD
STATE ENCROACHMENT
0 $7.00 PERMIT NO. C.1
717L LJJ
INDUSTRIALa_
ce)
WASTE APPROVAL
Lz" t..
L
OVVMRIS PERMIT $ 3 00 CHARGES
I CONNECTION CHARGE FEE
AUTHORIZATIONI TOTAL FEE c
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO
CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS—DAY OF 19
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS-
BUILDING OR WORK
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)
AND/OR DRATNFIELD
AND STATE THAT THE ABOVE IS Co RRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
RS, CESSPOOL 0 DRYWELL (j
ID HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSEAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIF C�p A
NIA OR THAT I . THE LEGAL OWNER Of,,/ AND INTEND TO DISCONNECT PLUG AND
RESIDE
IN. THE ABOVE
DESCRIBED RESIDENTIAL;PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PCIRMtrTCE- BACKFILL SEPTIC TANKS El
SEEP.PIT(S) Cl CESSPOOLS []
VAIII)ATION CK. lvl.o, CASH