HomeMy Public PortalAbout10216 RANDWICK DR_Sewer__ :E6OB3-c"2 7'6A642D APPLICATION FOR PERMIT
COUNTY OF LOSS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION rAEARESTT
UILDING
DDREss
JOHN A. LAMBIE. County Engineer
WILLIAM A. JENSEN° Supt of Building qy /'1� E $
FOR APPLICANT TO FILL INCRGSS S .71 --- -R --- - ----------- - -.T __._
DESCRIPTION LOT NO. OWNER
BLOCK TRACT y ADDRESS its -Teemp _ -_ - - --_._
SIZE OF LOT NOW ON LOT CITY ml pTp r "11' NG. AtAFPS1 8
BUILDINGS
USE; a DISTRICT NC•, G)X OUP MAP PROCESSED BY
--___ � - � BK PG
CONT RACTON Ten�ry .I.s fi Vega
AODRESs. .. ' .'a te CONNECTION DATA .;
-�Y (� -- -- - -- -- -
-"O i 1.74 '- X .'^" STATION ".� / n PTH
CITY' TEL NO.
—. UPPER
REGISTRAT••ION s `' 7" MANHOI F REKERENC E - / —
...-_� I_J COl-•N7Y
NO,. DES11ON OF WORKFEE --. --^ --_ TYPE OF C=ECTiON LENGTH FROM
---£-HOUSE SEWER CONNECTING TO --T —.-_ - Y.
PUBLIC SEWER
F P C.NO,
SEPTIC,TANK SEEPAGE PIT OR
°
PITS AND/OR DRAINFIELD `sI0.00 I —_—__CO.IMP,NO. JOB NO.
__.4-. OU___— T._..-__._-__._..
HOUSE SEW CR CONNECTING TO ! TRUNK PERMIT NO, ROAD PERMIT NO,
I PRIVATE DISPOSAL SYSTEM $3.00
,----_. _
r ON NEC7 ADDtTIONAt 6LDG OR AFFiDA 1T wAtVek' CASEMENT RECORD INSTR.NO. DATE
WOR!(TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT;CRA!N. IELD
E)cTN:,C.E55POOL.DF.Y WE:LL..MANFiOLE L� §5.40
_. _r_. H W'f.OR S7-WIDENING
ALTER,REPAIR OR ABA NDC;N y0 Sz
5 WER OP AiSPOSAL SYSTEM C?.,,$3.00 I STATE ENCROACHMENT
P FRMIT NO.
T
INDUSTRIAL
WASTE APPROVAL
_..__ .
OWNERS PERMIT �. 00 - - -CHARGES� _
AUTHORIZATION TOTAL FEE f �.z CONNECTION CHARGE FEE -
a
1 HAVE A'T' THIS DATE A CONTRACT WITH 'THE REIMBURSEMENT HEREIN NAMED CONI- ------- -- —- --FEE
--
TRAC`iOR TO COV NECT ?'HF ABOVE DESCRIBED EXISTING DWELLING ----- — --- --- — -- - ------r- -------- ----- -----
To
THE PUBLIC SEWER, APPROVALS II DATE INSPECTOR'S SIGNATURE:
SIGNED THIS,— ____DAY
OWNER OR �9 q�r NF'W HOUSE SEWER
OWNERS AGENT___,____�E.i�YS _ CONNECT ADDITIONAL I
ADDRESS BUILDING OR`N.OR.G
SEPTIC TANK.SEEP,PIT iS) Y
IHERE'3Y A KNOWLFD('F THAT i HAVE READ THIS APPLICATION AND;OR DRAINFIELD
A
ND STATE THAT THE ABOVE IS CORRECT AND AGREE T'O COMPLY
WITHALL COUNTY ORD INA <1ts ,AND SCATS LAWS REGULATING
P UMBING AND 5EW[RS y.' E SPOOL I� DRYW ELL, ❑ .___- _.�
1 NER'E BY CE RTlFY,, f!AT I. tn,M PROPERLY��rr"" tEGISTE.RED }SND/OR ALTER,REPAIR,SEWER
LI LENSED AS REQU 'D BY LOS ANGLES 4 NTY AND SLATE OF SEWAGE DISPOSAL SYSTEM
AL7FORN IA OR T T I AM THE LEGAL O IFy:ER OF AND,MVTEND TO DISCONNECT PLUG AND
RES:l DE ITJ; THE EI
DESCRIBED RESI E[4TfAL ,'ROPERTY, j
y L l ABANDON {O SSl SEWER 1
SIGNATURE
O.E' PFR.MtTTEE S� ....�.._.-R-.—_ x'-""`a^`u-„V�"yxA "W1_KFILL SEPTIC TANKS El
-- SEEP.PIT(S) L CESSPOOLS ❑I
VALIDATIONy ROBERT A. WOOD
,;�" '} SUPERVISING MECHANICAL ENGINEER
cr. M.o. ASH,,
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