HomeMy Public PortalAbout9063 RANCHO REAL RD_Sewer_1964-02-25 2"-
70
6A6421) APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION B','I LD I NG,
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCAL TY -------
NEARESI.
FOR APPLICANT TO FILL IN CROSS ST.
LOT NO. OWNER
DLSCRIPT,ON
MAIL
BLOCK T RAC:, ADDRESS
1'40.
SIZE Oi' LnT NOW 0 N LOT yo p CITY TEL. NO.
OF,
BUILD!N S
DISTRICT NO, GROUP MAP PROCESSEDBY
6 K FG
CONTRACTOR
P,
ADDRESS '2 ONNECTION DATA k,
DEPTH T
S (T•014
CIT
Y TEL.
JPPEFo
REGISTRATION NO CO
j STATE MANHOLE REFERENCE
UNT. 4t,
E
Na. j DESCRIPTION OF WORK. FEE PE�?
R
2N LNGTH FROI
I _ l M.L,TO P,L,
HOUSE SEWER CONNECTING To
PUBLIC SEWER @ $5.00 PC.N---
-9-ff-PT17C—ANK WEEPAGE PIT—OR ----- 7
PITS AND/OR DRAINFJELD @-sla.00 Co. IMP. NO
HOUSE 5tWER CONNr•C .NG TO
TRUNK PERMIT No. ROAD PERMIT NO
PRI✓A YE DISPOSAL SYSTEM @ $3.00 Zc-,—y
D N
AFgtoAVrr wAl-Vi-R-1—EASEMFNT RE-60--il�. s'rji NC. DATE
HOU
SE;WEBLDG.OR
WORK T� R $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
;5XTN.,CESSPOOL,�R�,�✓ELL,M.ANHOL.E@ $500
.........-------- -- - ------- : -1- - .
AL7E EJAIR OR ABANDON HOUSE HW" OR S1.WIDENING
SCWE of T M z
DiSPOSA;L F-
S R LCHMENT
tl PERM;TNO.
INDUSTRIAL
WASTEApPRQ .1 Lr�
CHARDES
OWN&-s�-PERMIT
CONNECTION CHARGE FEE
AUTH01:11ZATION T"
I HAVE AT THIS DATE A CONTRACT WITHTHE HEREIN NAMED CON. RE! L F
E �RZEM NT_ EE
TRACTOR
CONNECT THE ABOVE DESCRIBED EXISTING
TO THF_ SEWER. APPROVALS
E PDATE I INSPECTOR'S SIGNArURE
SIGNED THIS--DAY OF 19
OWNER OR 71
NEW HOUSE SEWER
OWNERS AGENT---
-2
"x
CONNECT ADDITIONAL
_BULlDiNG OR WORK
ADDRESS
SrPTICTANK SlZrP.P!T�S)
EBY ACKOWLEOE THAT I HAVE READ THIS APPLICATION AND'OR t>RAINF--
ILp
A� H0SE7NCATE THAT THE ABOVE: IS CORRECT AND AGREE TO COMPLY
WITH ALL CNCE
OUTY ORDINANCES AND STATE LAWS REGULATING
PL-L:M S ING AND SFWERS. CESSPOOL ❑ DRYWELL ❑
i
rFEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR AL-ER,REPAIR. R OR
LICENSED
AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISP05AL SYSTEM
-CALiFOPNIA 0 T" m HE LEGAL OWNER OF, AAD INTEND
RESIDE
IN " TH�� RTY. PLUG
ES THE 1� Pei-c'zlarn RESU�ENTI�,L'P�pp]-E ABANDON HOUSE SEWER
SIGNATURE
EOF PERMITTEE BACK911-LSEPTIC
TANKS
SF.FI7LS) D
CESSPOOLS f]l
VALIDATION ROBERT A. WOOD
SUPERVISING }41ECHANICAL ENGINEER
CK. M.O. CASH
80 8
BEA642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE OISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
AD
IN
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSENI Supt of Bullding
LOCAL; Y
L D
R EI
A L
-------------
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTIONOWNER LOT NO.
IL
BLOCK TRACT
ADDRESS
_ n
NO. OF BLDGS.
SIZE O':_
LOT NOW ON LOT Ci TY TY
TEL. NO,
USE OF
.11ILDIN DISTRICT NO, GROUP MAP PROCESSED BY
PrI
-K
CONTRACTOR
ADDRESS CONNECTION DATA
4
S Aifo,,
CITY
STATE F'ERENCE
MANHOLE RE
REGE ON NO. -1 COUNT
aTRAT
NO.r C, SCRIPT 10,14 OF WORK FEE LENGTH FR �w
E T�filt OF coprNET�,
HOUSE SEWER CONNECTING TO Y, m..L.To P U
@ ✓
PUBLIC SEWER .5-
$5.00 4L NO. ZL
JOB NO.
EFTiC TANK SE PAGE F I 1 0
PITS AND?OR DRA0NFiELD @ slo.00 GO. IMP NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERf4IT NO.
PRIVATE DISPOSAL SYSTEM $:3�00
WAVE DA
A
C6NNECT ADDITIONAL BLDG--.OR W
Vif WAIVER EASEMENT R�L60 r.INSTR.NO, D
WORK YO HOUSE SEWER @ $3,00
'OVERFLOW SEEPAGE PIT,DRAiNFIELDU
XTN.,CESSPO OL.DRYW -M
ELL. A IN HOLE @ $5.00
ACfER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
to
SEWER OR DISPOSAL SYSTEM @ $3.00 --------
Z _ _ STATE ENCROACH MENT z
PERMIT NO.
!NDUSTRIAL WA TE APPROV
AL j,
j
CHARGES
0 PERMIT 21 00
CONNECTION CHARGE FEE
AUTHORIZAT ON TOTAL FEE
I HAVE
AT IHIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REiMBURS 6!ME NT FEE
T RACTOR TO
B0 CONNECT THE ABOVE DESCRIBED EX15T!UG DWELLING
1,
TO THE PU L _
SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS-—DAY OF ^. t9^ — -- `--- —`' "— ---
I -
OWNER
FOWNER OR NEW HOUSE SEWER
OWNERS AGFNT------0-0—'- CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS——
SEPTIC TANK,SEEP,PIT(S)
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAtNFIFLD
AND STATE THAT THE ABOVE iS CORRECT AND AGREE TO COMPLY
WiTALL COUNTY ORDINANCES AND STATE LAWS REGULATING
FLUMEI;NG AND SEWERS. CESSPOOL ❑ DRYWFLL L-1
IH REBY CERTjFY THAT ASI PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
E I
LIC EN 5 ED AS REQUIRED BY LOS ANGLES rOUNTY AND STATE OF SEWAGE:DISPOSAL SY5iI,.m I
rAL
Rt_SlIFORWA OR THAT IE by k{E LEGAL OWNER OF-41 9ND INTEND TO DiSCONNFCT PLUG AND
DE IN, 7HASO EA,CR RZS;Di;,FTIAL. 0OPERTY,
Z- ABAN CON HOUSE SEWER
SIGNA
TURE BACKFIL.L.SEPTIC TANKS Ll
OF PERMITTEE SEEP,PIT(S) L CESSPOOLS E)
VALIDATION— ROBERT A. WOOO
CK. M.O. CA S H
SUPERVISING MECHANICAL ENGINEER