HomeMy Public PortalAbout9046 RANCHO REAL RD_Sewer_1956-06-27 76A6-63 3,`56
5 E-666APPLICATION l ■ ION F V PERMIT
R&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING � r
WM.J. FOX, COUNTY ENGINEER _ ADDRESS � x
CASSATT 0. GRIFFIN, SUPT OF OUILDING LOCALITY_
NEAREST
FOR APPLICANT TO FILL IN
_CROSS ST. .�,,:",* 4,y, '
LEGAL ,�,�,Y
DESCRIPTION_ LOT NO._ Y OWNER �-",;,k
BLOCK vTRACT ,€ ? MAIL
_a.—.-�......a_ ADDRESS—
NO.
OF BLDGS,
-SITE OF LOT _ NOW ON LOT CITY TEL. NO.
USE OF e
BUILDINGS - --- —- DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR
ADDRESS CONNECTION
CONNECTION D�il
CITY. . £L. NO. ----$ `°� -L STATION - DEPTH
[j STATE MANHOLE REFERENCE `. R
REGISTRATION NO -- � - - --
TYPE Qf' COP{NECTI^N LEN LOWER
NO. � DESCRIPTION OF WORK FEE
- -- -_�_. _�_ GIH FROM
HOUSE SEWER CONNECTING TO �:-�,. Y, CLRB P.L. l:.,L. TO P.L.
I PUBLIC SEWER _ C'I?_ S 3.5 _._.._a�_ -- ..---- -._--_...., .__.- -- --- ---
rt^USE SLYdER CCNNEGTING TO i
PRIVATE DISPOSAL SYSTEM 1.00 -_ - -- ----- �.- -�
CONNECT ADDITIONAL BLDG. OR P. C. N0.
VIOR--
ALTERT'1 REPS_£SEWER _ 1:00� Co. IMP. N0.- � JOB NO,��------
A�.TER OR REPAIR EXISTING -
5£YlER OR DISPOSAL SYSTEM 1._00 I. _ TRUNK P RMIT NO ROAD PERMIT NO.
-� DISCONNECT AND ABANDON SEWER -
_ AND/OR DISPOSAL SYSTEM I-001 STATE ENCROACHMENT
`.� PITS SEPTIC TANK,SEEPAGE FIT OR INDUSTRIAL - -----_-,_-.._._._..®-_.'-- -_-__-
PSIS ANDER DRAT*FIELD �.00 � W.ASTk APPROVAL
CESSPOOL DRYbtEi.L
SPECIAL COND1TION5 ONLY 2.00 CHARGES
. -- 'I---- CONNE'CT'ION CHARGE FEE
OWNER'SOWNER'SPE —..
RMIT 1(___CO _.._.�.----- ---- ------ —_..
1 -_
AUTHORIZATION —TOTAL FEE —� �` � �f REiMBURSEMEr _EE£
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS GATE INSPECTOR'S SIGNATURE
TD THE PUBLIC SEWER
NEW HOUSE SEWER :I
SIGNED THIS— ;—?�AY F
OWNER OR
CONNECT'ADDITIONAL
OOWNERSAGEei3 .
G717T-' -• - ILUIN OR WOR` � .BUD. -
ADGR£5S- SEPTIC TANK SEEP, PIT(S)
AND/OR DRAIdFIELD y
i HEREBY ACKNOWLEDGE THAT~I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL nAND STATE. THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
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/QP.
LlGENS£D AS REOPIRED BY LDS ANGELES COUNTY APi SATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL QWNER 0 Tt�,E ASOV'E ABANDON HOUSE SEWER
DESCRIBED RE TIAL PRF TY. BACKFILL SEPTIC TANKS C tf I
SEEP. PIT(S) El CESSPOOLS 1_•;
SIGNATURE
OF PERMITTEE
WILLIAM J. F449.COUNTY ENGINEER VALIDATION R.A. WOOD, CHIEF PLED. INSPECTOR