HomeMy Public PortalAbout9115 RANCHO REAL RD_Sewer_1959-01-15 76A64
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=eor� APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building y 6 1
LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL yAa
DESCRIPTION LOT NO. OWNER
BLOCK ✓. TRACT ,y',/. ADDRESS
_ NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 'S CITY TEL.NO.
USE OF
BUILDINGS s ! .Jr,C;;�Y:%,r-" r DISTRICT NO. GROUP MAP
CONTRACTOR /"r ✓'' R / .'"" -., � a''f�, .8K PG
ADDRESS CONNECTION DATA
CITY !. /1s TEL.NO. STATION .y, DEPTH
/. STATE. MANHOLE REFERENCE �-- — — UPPER
REGISTRATION N0. COUNTY —`--
Na. DESCRIPTION WORK FEE LOWER
HOUSE SEWER CONNECTING TO
SE TIC SEWETANK.
$3.50
_ TYPE OF-CMA-E~TION LENGTH FROM --- s—
SEPTIC TA'IK S^'EPAGE PIT OR Y. CURB_ P.L. M.L..TO P.L.
PITS AND/ORORAINFIELD Q $9.00
OVERFLOW SELPACE PIT,DRAIN FIELD
EXeN.,CESS.P00L,DRY4IIELL,)dANHOLE P $2,00
HOUSE SEWER CONNECTING TO P.C.N0. -- —
I PRIVATE DISPOSAL SYSTEM (a $1.00 CO.IMP.N0. JOB N0.
CONNECT ADDITIONAL BLDG.OR — ----"---- —
WORK TO HOUSE-SEWER _ $1.00 I r' TRUNK PERMIT NO. ROAD PERMIT NO." -
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL..S 5TEM $1.00 STATE.ENCROACHMENT
-��— -�- PERMIT N0.
INDUSTRIAL
WASTE
--
WASTE APPROVAL
CHARGES
OWNER'SPERMIT g OO, CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
) HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE IINSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER, --- -------,.-,--
SIGNED THIS ;Z DAY OF —j ,�.' _._19 Y _NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_ /` [ !•-''�'.�.�y 1� i _ _BUILDING OR WORK I -
kDDRESS SEPTIC TANK,SEEP,PIT($)
_—. - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE: IS CORRECT AND AGREE TO COMPLY CESSPOOL D DRYWELL L_j
WITH All, COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBINGANDSEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _aEWAGE DISPOSAL SYSTEM _
LICENSED AS REQUIRED SY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG.AND
CALIFORNIA OR THAT i„AM THE LEGAL OWNER OF THE ABOVE _ABAHDON_HDUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ -
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS 0
OF PERMITTE �f°! Q s t's- ✓"` -- -.
Yee VALMATION ROBERT A. WOOD
C1c.
M.0. CASH SUPERVISING MECHANICAL.ENGINEER