HomeMy Public PortalAbout9076 RANCHO REAL RD_Sewer_1959-01-30 76A6420
E-6ea is.ss APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING!
JOHN A. LAMBiE, COUNTY ENGINEER ADDRESS . ------ _ -�- — -,-^—
J CASSATT I), GRIFFIN, SUPT OF BUILDING LOCALITY
�Ft3It APPLICANT TO FILL IN DEAREST ;
CRUSS ST. _
LEGAL ------- OWNER
-DESCRIPT,ON,: LOT NO. '
-"- --
BLOCK S TRACT I MAI L
ADDRESS
NO. OF BLDGS, r' CITY TE[.. NO
SIZE Or LOT° - - NOW ON LOT -
S E BUILDING •t _— is -
CONTRAC. �� a DISTRICT NO. .GROUP i -MAP
USE OF
-- - -- -- i I
SK - PG
TG
CONNECTION DATA
ADDRESS 'r. _ �� d ..3.1 �r ��� �.. d - -- -_
y aTATION
-
CITY ' TTi
EL. O.i- „pT' ,d.1.-t'r6 .s
',:- MANHOLE REFERENCE
a %i/ ❑ STATE:
REGISTRATION HO. �,� - �,,�✓;' '�y alrj COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE
TYPE OF CO¢�.� tON --- LENGTH FROM
I HOUaE SEWER CONNECTING TO -�-- T_ y };�! B P.L. --" -
--J_ �`USLIC SEWER _ L$ I - -PL
...-,- -_�...._
1 SEP'T1C TANK,SEEPAGE PIT OR _ r
-j PICS AND/OR SEEPAGE
tLD (- S 3.D0 j --..---_..— —__---- _._-- ----_-----
OVERFLOW SEEPAGE PIT,DR I iFIELL P. C. N0,
t,XTN.,CESSPOOI.,.DRYiq"ELL, :e (�. $2..CO�..�-�--- JOB NO. _
._-... ---- --- --a`-.1.-�—_.-
HOUSE SEWER CONNECTING TC,
PRIVATE DISPOSAL SYSTEM �X $1.00 (PUNK PERMT NO ROAD PERIdIT N0. ,yd.. '•
__.. ---- -- --"
CONNECT DTIZIi Uri AL BLDG.OR ( STATE ENC ROACH`IENT
WORK-TO H4 S � V _t✓Ie�-�Jr` ct i.GD PE'?MI NO.
- -
AL1EP,R AIftOR ABARDCPJ H `
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM �- $i_.i)0 i WASTE APPROVAL
I CHARGES.
CONNECTION CHARGE FEE .-..--
®WNER`S PERMIT ooE:mBURSEMENT FEE -----------
AUTHORIZATION TC)T-AL FEE I T I �`�` FiPPR®V�y15 DATE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -_ ___—__ 11IN SPEC7Ur2SSIGixh L'ilE_
TRACTOR TOCONNECT THE ABOVE DESCRIBED EXISTING DWELLING
I.O T E U 3 L I C VW EP. - NEW HOUSE SEWER
SIGNED THIS__ DAY OF__�wv _ 19_ CONNECT ADDITIONAL fi--
OWNER OR ` BUILDING OR WORK - - -
i
OWNERS AGEN1 SE,PTICTANK,SEEP,.PIT(S) .--
ADDRESS :_' �_ -T -AN-D,'OR DRAINFIELD---- �u -
'.
H15PEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL;1 URYWELLL7 I I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY . __.__ _ .._ _.__
' (ILH ALL COiUNTY CRD NANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR I_----�-_----_�-~-----
PLUMBING AND SEWER,. _SEWAGE DISPOSAL SYSTEM
--' REEY' CERTI Y THAT 1 ANI PROPERLY REGISTERED AND%OR DISCONNECT PLUG AND a ^�
LICEN sE;L` AS RC.fzU R=.0 ,Y LOS ANGELES COUNTY AND STATE. OF ABANDON HOUSE SEWER �
CAL!FORNIA OR THAT I '+ht THE EGAi ) ER OF THE ABOVE --- ---.._. _---------,�-- -i--.—.__-----. __----
-DES Ci<lBED RE I,�LNT{AL T�SiPER�1 _!> � t_ BACKFILL SEPTIC TANKS ." ..
SEEP. PITS) E] CESSPOOLS 0 t
SIGNATURE
OF PERMITTEE
)OHN A. LAMBIE. COUNTY ENGINEER VALIDATION '',,,ROBERT A.WOOD, CHIEF PLBG. INSPECTOR,
GK, bd.O. SASH
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