HomeMy Public PortalAbout10202 RANDWICK DR_Sewer__ (111Tf
CES08 3-6?
APPLICATIONS FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN. Supt of Building
LOCALITY Jal(Aple 1y. ity
R,
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.0111 -Ave
LEGAL
—OLESCRIPTfON LOT NO. OWNER
MAI L
_BLOCK TRACT ADDRESS Tomple City ?lvd6
NO. OF BLOG!i. C i, A t "^' 3 1,5
SIZE OF LOT NOW ON LOT -IyY
USE OF
StJiLDiNGS lResiderice DISTRICT NO. GROUP1 MAP PROCESSED BY
_C'--)NTRACTOR
--—- - --
ADDRESS CONNECTION DATA
_JIM_,%__A
CITY STATION DEPTH
_Ly&_ ------
STATE
REGISTRATION302525 LOU
O UNTY MANHOLE REFERENCE
Ne. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM ,
HOUSE SEWER CONNECTING .O CURB P.L. M.L.TO P.L.
PUBLIC SEWER @b
s nc— -PFr6W'
Ep TANK.sffEPAbE
--j_PITZ AND/OR QRAINFIrLD @ $1[1,00 CO.IMP. NO. I B'N 0: U
@ 0
PIRWATE DISPOSAL SYSTEM TO TRUNK PERMIT NO. ROAD PERMIT NO.
HOU T
40 SF SEWER CCNNEZTINi�
WORK TO HOUSE.SFWER @ $:3.00 CON NEC!AD'S TIONAL BLDG OR AFFIDAVIT m��R I EASEMENT RECORD. iNSTR.NO. DATE
- AINF1 ELD
OVER IL11W SECPA�Pli,15R
OV
�EXTN.,CESSPOOL.DRYWEL.L,MANHOLFO 55.00
IT -dUSff HWY. OF?ST WIDENING
0R
ALTER,REPAIR ABANDON H
SEWER OR D)SPOSALSYSTFM 3�3.00
STATE ENCROACHMENT
i PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER'S IT 2 00 C I HARGE-S
CONNECTION CHARGE FEE
AUTHORIZATION[ ", /''
I iiAVE AT THIS DATE A CONTRACT WITH THE 11.11.111 NAMED CON- REIMBURSEMENT FEE
RACIOR To ASOVE DESCRIBED EXISTING DWELLING
TO THE PU19LIC SEWER.
APPROVALS DATE INSPECTOR'S SIGNA-URE
S1t,NED 7HI5---DAY
OWNER OR NEW HOUSE EWER
OWNERS AGFNT--- liew S
CONNECTDDITIONAL
A
ADDRESS— BUtLD4-N G Of,WORK
I 14FREBY ACKN THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
QWLrDOE EPTIC TANK,SSEP,PiT(S)
AND
STATE THAI, THE ABOVE r$ CORRECT AND AGREE TO COMPLY
O M P L y
WITH ALi. COUNTY LARQiNANCES AND STATE LAWS REGULATING
PLUMBING ANO SEWERS: CESSPOOL L] DRYWELL ❑
I HERE BYJ(;ERtIFY .THAT I AM, PROPERLY REGMTEREyD AND/OR ALTER,RE PAIR,SEWER OR
LICENSED lf.`13,AEOMIkED BY LOS AN
GLIE�-COUNTY AN,0 STATE OF _SEWAGE DISPOSAL SYSTEM
CALIFORNIA)6R T�-tXt I AM THE LEGAi,,-t3' OF, AND INTEND 70 1 ---- —_--------4-1—�----- ---- --—_-_.
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RESIDE iNjj'rHE,AB5�WE DESCRIBED "5 - TIAIj PR,?��PTY. DISCONNECT PiUG �,ND
7 A13AN-DON HOUSE SEWER
I,'
SIGNATURk >I�
BACKFrLL SEPTIC: TANKS
OF FERMtTTEE
L -Ltz SEEP.PIT I S) CESSPOO
❑
VALIDATION ROBERT A. WOOD
M.01 c,Asy
SUPERVISING MECHANICAL ENGINEER