HomeMy Public PortalAbout9085 RANCHO REAL RD_Sewer_1958-10-20 r
'GAE-6F 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. L�,MBIE.COUNTY ENGINEER ADDRESS LOCAL.7 ✓ irk s
CASSATT C. GRIFFIN, SUP'T OF BUILDING LOCALITY
®II a PPLICAIdT T® FILL IN NEAREST
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LEGAL ---�-- ----- -
-DESCRIPTION LOT NO, / 1 OWNER y
BLOCK �� TRACTJ MAIL,
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SE OF LOTNOOF BLDGS.
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MANHOLE REFERENCE
STATE
REGISTRATION NO. COUNTY
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No. DESCHI-PIION OF WORK FEE ----- -----------.__—_�_�-__
.----:..___..�------.___._--,-_ ..- TYPE OF CONNECTION -LENGTH FROM
Hotly sEWER CONNECTING ry
PU6LIC SEW€R a .,, u�r Y. CURB P,L. M.L.Z'0 P.L.
SEP-IC TANK SEEPAuE,PIT OR
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PITS AND/OR DR.AINFIELD (t $3.00 -
OVERFLOW SEEPAGE PIT, DRA NFIELD P C NO,
! tXTN„C SSPOOL,DRYWELL,M NHOLE f $2.001 CQ. IMP. NO. .iOB NO.
HQUSE SEWER CONNECTING iG
PRIVATE DISPOSAL SYST ?$ PUNK PERMIT NO ROAD PERMIT NO.
A
CONNECT ADDITIONAL BLDG On S 7'E ENCROACH[d'riiT
WORK TO HOUSE SEWER $1.0c,
NO._ r HMIT N .
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ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
EWER OR DISPOSAL SYSTEM (a 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PE3i1�IlT � 1 -1
n0
iEIMBU2SEMENT FEE
AUTHORIZATION TOTAL FEE — - APPROVALS
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I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED Cr' d1P.lk"lt'b7YAL17-__._I,.._DA7E �iNSPEC"i U"t�55iGPJA7URE
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TRAGIcJR TO CONNECT THC''_ ABOVE DESCRIBED EF[STING DWELLING
TO THE PUBLIC S VIE'R.p�" I ,: `—” � NEW OU t SEWER
SIGNED THIS "~ DAY OF �� — ._._.____ _-
- `—
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P�J1L_.D FCyTr tnI 4': L
OWNER OR
OWNERS A ENSPTirIAK.SEEP,P—ITIS)
ADDRESS K Lk.S' € THAT I HAVE yid D/OR U AINF�Ebp i --'.---'-
I HEBEBY E READ THIS APPLICATION
AND STET. T_• THE ABOVE IS CORRECT ANL, COMPLYCESSPOOL',]L] 1R V'£I_L t.
WITH ALL iCUNSY ORDINANCES AND STATE LAWS REGULATING ALTER,R-PAIR,SEW R )R 1
PLUMF31NG AND SF''VVERS, SEVIACE DiSPOSAL S_STEM !
i PEREB'Y CERTIFY THAT i ASI .PROPERLY REGISTERED AND/OR L'�ts'CONN€C'r PLUG AND -�- -�— ------
LICENSED AS REQ_, IRED BY LOS ANGELES COUNTY AND STATE QF ABANDON HOUSE SAND '
CALIFORNIA OR THAT t 51 THE LEGAL OWNER,---.OF THE ABOVE —.-__- _.- _- - - _-_-__-_----
DESCRIB`E'D RESIDENTI OPERT °': BACKFILL SEPTIC TANKS 0 �
SIGNATURE I ,,. SEEP. PIT(S) ❑ CESSFOOLS,_)OF PERMITTEE _ =�0"or
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)OHI\{A. LAMBIE, COUNTY ENGINEER VALIDATION_._ ROBERT A.WOOD, CHIEF PL.BG. ;INSPECTOR
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