HomeMy Public PortalAbout9040 RANCHO REAL RD_Sewer_8/2/1954_30785S DEPART.BEENT OF COUNTY EN01NE s SgWER----SEWAGE DISPOSAL 1
DIVISI.ON OF BUILDING AND SAFETYPERMIT APPLICATIO_ N
COUNTY OF LOS ANGELESUILDING -
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS ��el 2 rf P
FORAPPLI ANT TO_FILL IN LOCALITY
ADDRESS ®� O NEAREST
CROSS ST.
LOCALITY 1 L+mob .� DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST^ A
CROSS
REECCE�F-EDiv.LIX y Ready for Inspection /DAT ISS fD
OWNER /(�� F1c�i `�C�
MAIL
ADDRESS / U,SPEEZZONE'®*' OCCUPANCY BK'MA PQ
CITY ' TEL MO. .S�Q(2 I"
CONTRACTORf , -3" 7 �®
�/ Co.imp.N0. //
.
ADDRESS ! 6,�� �' /f �Sf S / JOB.N0. • J --
CITY +TTEL.M040 elle(1J O TRUNK PERMIT NO.
REGISTRATION NO. ` J ��A y r/ ®:COUNTY.I ROAD PERMIT NO. 27452
LEGAL D STATE ENCROACHMENT a
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT 1 WASTE APPROVAL
NT
LOS `CHARGES
NOW O
USE OF " r I CONNECTION CHAII E
BUILDINGS i
NO. DESCRIPTION OF WOR _ FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO ! Iv TE I BY
PUBLIC SEWER a $ 3.50 r RECEIPT NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
WORK CONNECT HOUSE ADDITIONAL
SEWERLDG.OR 1.00 � , EXCEPTION RECORD
ALTER OR REPAIR EXISTING / NO. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2A0 STATION s ! DEPTH
CESSP00 L—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 S ANHOLE-REFERENCE
UPPER—
TYPE
PPER- � L-0SYi;R�
TYPE�OwtIQN.MRGTION LENGTH FROM /
CU B - M:L.TO P.L.
OWNERS PERMIT - S 00
AUTHORIZATION TOTAL FEE �f
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR TO CONNECT THE ABOVE DE CRIBED EXISTING APPROVALS INSPECTO SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _DAY OF Iq NEW HOUSE SEWER, ��P-,__ g �. y
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN BUILDING OR WORK
BU10017- ILDING
TANK.SEEP.PIT(S)
ADDRESS .�� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE -61f 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 REGISTED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTREY-
DISCONNECT PLUG AND
AND'STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-- ABANDON HOUSESEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 1
SIGNATURE - SEEP.PIT(S)11-CESSPOOLS:.
OF PERMITTEE
7a ARA9A 992 7/6Z _
111ZI-11 w
7
Esoa-a-88
C808•e APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer _ADDRESS —
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APP CANT TO FILL IN CROSS ST.
LEGAL —
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
- ADDRESS _
1110.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP � PROCESSED BY
BK P6
CONTRACTOR e n
'�°id
ADDRESS
CONNECTION DATA
CITY TEL. NO. STATION DEPTH
STATE MANHOLE REF£RENC UPPER
REGISTRATION NO. COUNTY LOWER
ft
y.:USE SEWER CONNECTING TO sr k'BLIC SEINER r� $3.00 `
SEPTIC TANK,SEEPAGE PIT OR TYPE UF CONNECTION LENGTH FROM
PIT'S AND/OR DRAINFIF_LD @ $3.00 X. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL„DRYWELL,MANHOLE @ $2.00
HOUSE, SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
T BEWrR OR DISPOSAL SYSTEM @ $1.00 ” PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNmS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA .FD CON, APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF-19— NEwi_HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP,PIT(S) _
ADDRESS -- _ -_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELLI7
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
DISCON
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCON N HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE —
DESCRIBED RESIDENTIAL PROPERTY Y BACKFILL SEPTIC TANKS
SIGNATURE .. SEEP. FITS) CI CESSPOOLS 13
OP'PERMITTEEZ v -
►• `-f"y' LID
AATION ROBERT A.WOOD
CIC:: .' Y.Q. CA6K SUPERVISING3 MECHANICAL ENGINEER
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