HomeMy Public PortalAbout9108 RANCHO REAL RD_Sewer_1953-06-02_9397S ` DEPAIVfMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS _ CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL — ----__�_
ADDRESS USEZONE 11GCUPANCY MAP
— --— + BK PG
CITY r? Pim- Y TEL.NO.
CONTRACTOR
—-- —,_� CO.IMP.N0.
ADDRESS
!OB NO.
CITY TEL.NO.
TRUNK PERMIT NO.
[] STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRTTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT �N0.OF BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE
------ REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM LGO
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N DATE I BY
_SEWER OR DISPOSAL SYSTEM
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
_ P 4-.118.----.. LOWER
TYPE OFCONNECTIQ1 LENGTH FROM
OWNERS PERMIT
Y. CURB F'.t.— M.L.TO P.L.
S
AUTHORIZATION TOTAL FEE I 00
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS..:.................DAY OF...... 19..._... 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❑ DRYWELL
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT
ABANDON HOPLUGAN_D
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS
SIGNATURE
OF PERMITTEE--• ------ --- ---------------. __-..................
76A642D 663 1/53 .