HomeMy Public PortalAbout9055 RANCHO REAL RD_Sewer_11/12/1953_18595S DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE (DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY Ole LO ANGELES
WILLIAM J. FOX, COUNTY EN[31NEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING
ADDRESS NEAREST
---------�-_--__^�------ CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A J
c
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL _ MAP USE ZONE OCCUPANCY
ADDRESS — BK PG -
CITY TELAO.
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
REGISTRATION N0. [j STATECOUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. CHARGES
USE
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF W17RK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 RECEIPT NO. ! DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL-BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- DATE j BY
SEWER OR DISPOSAL SYSTEM 1.00 f
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CETSPOOI—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 1 00
AUTHORIZATION I TOTAL FEE 11
I 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
SIGNED THIS.............. OF_..... .............—.........14.-___ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
_ _.._.....------....._._.. _.._..._
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--.--- - .........- -......------------_....................._....._........... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL C]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 REGISTERED DISCONNECT PLUG AND
ST
AND/ LICENSED REQUIRED BY LOS ANGELESCOUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIAF THE OR THAT I AM THE LEGG AL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E
SIGNATURE SEEP.PIT(S)0 CESSPOOLS(
OF PERMITTEE.e — _... i
70A642I) 663 1/5$ ��