HomeMy Public PortalAbout9039 RANCHO REAL RD_Sewer_1965-11-19 z
E808 10-63
6A642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION DU!LDI NG
L
A
_9 R=. dio Real
JOHN A. LAMBIE County Engineer -------
WILLIAM A. JENSE� D DR E 3 S, Sup't of Building 'Lp
LOCALiTy
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN
DESCRIPTION LOT No OWNERIjelka
MAIL
BLOCK TRACT ADDRF-S CIO" 1S;=Ch
_0
NO, OF BLDG S.
SIZE OF LOT NOW ON LOT Calif. NO.
USE OF D'S 1 CY NO.1 GROUP MAP PROCESSED BY
BUILDINGS BK P3
CONTRACTOR
ADDRESS 2185 N. Fair Oaks CONNECTION DATA
STATIONDEPTH
STATE
MANHOLE REFERENCE
_REGISTRATION _7�1_C42 COON"Y
NO. j_-DE CRIPTION OF WORK FEE LEN GT H FROM
ES TYPE:OF
HgU5E SrWER CONN ECTNG TO Y. RI1� P.I_ M.L.TO P.-
i
PUBLIC SEWER @ $5 GO P.c.NO,
SEPTIC TANK,SEEPAGE PIT OR CO, IMF,NO. JOB NO 0
ITS AND/OR DRAINFfELD @ $10.00
HOUSE$EWER CT I N_GT 0 CTRUNK PERMIT NO. ROAD PERMIT NO. LJ
O N IN E T
PRIVATE,DiSFOSAL Sl @
-CONNECT- Y -RFrE_coRDiNsi:W_Nc DATE 0
WORK TO HOUSE SEWER @ $3.00
ORAINFIEED
EXTN.-CFSSPOOL,DRYWELL.M.ANHOL.E @ ASkN HOUSE $5.22_—
ALTER ffFHWY.OR ST.WIDENING
R _A_JR di�
SEWER OR. @ $3.00 I.
—STATZ 5t��ACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEWS PERMIT s 2� 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RIE�,NIBURSEMENT FEE
T RACT 0 TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ---
TO THE RP1JBLtC Sj§%. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY er 65
7—
OWNER OR 4 NEW HOUSE SEWER
OWNERS AGENT_iL �ONNECT ADDITIONAL
ADDRESS 39RanCh-0 Real, Tempp!,_ City, Cal UILDING OR WORK
SEPTIC TANK,SEEP,PIT($)
I HEREBY ACKNOWLEDGE THAT E HAVE READ THIS APPLICATION ANDi OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
RS. rESSPOOL E DRYWELL
I HEREBY
CERTIFY THAT--1 AM PROPERLY REGISTERED AND/ORALTER.REPAIR,SEWER OR
'
LICENSED AS REQUIRF_0fWe' LOS ANGLES COUNTY AND STATE OF S EWA GE D'SPC SAL SYSTEM
CALIFORNIA OR THAT T HE LEGAL OWNER OFAND INTEND TO
PLUG AND
��'D�:CR[SEE, P N��IAL PROPERTY. ABANDON HC Sr.WER
RESIDE IN, TH� E
SIGNATytt
BACKF ILL SEPTIC TANKS
OF PER SEEP,PIT(S'I Ll CFSSFOOL4
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. O. CASH
L"7 4 6 2-N� NOV 19 1 D 7.00-