HomeMy Public PortalAbout9070 RANCHO REAL RD_Sewer_1961-06-14 24650 INSERTS
`EAG46-60
'��AsaDAPPLICATION FOR PERMIT 1
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COUNTY OF LOS ANGELES SEWER SEWAGE .DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING- ,> `--
BUILDING AND SAFETY DIVISION AD A r ✓ --«
tOHN A. LAMBIE, County Engineer a I
LLIAM A. JENSEN, Sup't of Building LOCALITY „r
NEAREST
FOR APPLICANT TO FILL rN CROSS ST. y
—'
LEGAL OWNER s
DESCRIPTION LOT N0. -
BLOCK TRACT MAIL
- ADDRESS
NO.OF BLDGS. -
SIZE OF LOT NOW ON LOT CITY TEL. NO. - '
USEOF
DISTRICT N0, .GRO,UP� - MAP - PROCESSE&BY
BUILDINGS /
— BK PG
CONTRACTb -
ADDRESS * '� C NNECTIO,4 DATA,
CITY ++� f,?TEL.NO. STATION i t DEPTH S
❑ STATE MANHOLE REFERENCE y''� ;�' 4UPPFR
REGISTRATION NO. �] COUNTY „`"
r 4
NO. DESCRIPTION OF Yy'6RK FEE
ItOUo.E S. VI R CONNECTING TO J
PUBLIC SEWER_ @6 $3.00 � TYPE OF-6NNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y, CURB P.L. M.L.TO P.L, .
PITS AND/OR DRAINFIELD +a $3.00 — _
F�OVERFLOW SEEPAGE F T DRAINFIELD -.
CESSPOOL DRYVWELL @ $2.00
HOUSE SEWER CONNECTING TO '.-' ✓ a✓ P.C.NO.
�--���� ���� CO. IMF. NO. ✓ J JOB NO.
PRIVATE
SAL SYSTEM @ 31,00 —CO-
CORK TO ADDITIONAL BLDG,OR I ''. M TRUNK(PER N0. ROAD PERMIT N0, U
+
WORK TO HOUSE SEWER @ $1.00 �i ✓��-� �
ALTER., REPAIR OR ABANDON HOUSE STATE ENCROACHMENT p'j
SEWER OR DISPOSAL SYSTEM @ $1,00 _PERMIT NO, O
—INDUSTRIAL- U
_ WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 00 CONNECTION CHARGE PEE
AUTHORIZATION TOTAL FEE I ffl� e REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE tINSPECTOR'$SIGNATURE
TO THE PUBLIC SEWER. —
SIGNED THIS—DAY. 13 NEW HOUSE SEWER
OWNER OR d �' �'p ,,a —NEW
ADDITIONAL
OWNERS AGENT �6 F: tC-`f•<-�- '--✓` BUILDING OR WORK -
ADDRESS - SEPTIC TANK,SEEP.PITS)
----- _AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL {�
WITH Al'L COUNTY ORDINANCES AND STATE LAWS REGULATING —ITER,REPAIR,SEWER OR
PLUMBING AND SEWERS. AER,
DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON ROUSE SEWER
CALIFORNIA 0R THAT I AM THE LEGAL OWNER OF THE ABOVE - —
DESCRIuED RESIDE y. AL PROP TY, BACKFILL SEPTIC TANKS
SIGNATURE t, SEEP.PIT iS) L7 CESSPOOLS Cl
OF PERMITTEE / y
1
�F VALIDATION- ROBERT A. WOOD
6K. M.0.. �"SH SUPERVISING MECHANICAL, ENGINEER
..i •3" �j kw'J v. R ... c"y
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