HomeMy Public PortalAbout10224 RANDWICK DR_Sewer__ TUTLE CITY
CE808 3-62
76AS42D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BIJ iLD I NG
B
JOHN A. LAMBIE, County Engineer ADDRESS andwick D_r .
WILLIAM A. JENSEN, Supt of Building -- -102,Z*-3,-R-
LOCALITY Temple Gi*.jY
NEAREST
_C
FOR APPLICANT TO FILL IN ROSS ST,
_DESCRIPTION LOT NO.
OWNER
4be
BLOCK TRACT 27309 ADORES S -592 6
ty
NO- OF' BLOGI.. Tem P.1 e Utv
SIZE OF LOT NOW ON LOT' CITY N o. At . 6,22 3 18
USE. 05
BUiLDINGS DiSTRICT NO. GROUP MAP PROCESSED BY
8K PG
CONTRACTOR IT
4-
ADDRESS CONNECTION DATA
��TAI ION DEPTH
CITY So 13 SL n (I asbr el At 0-47
-0 STATE
�p 52 5 MANHOLE REFERENCE
REGISTRATION OUNT ER
,;L6w
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION
LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB
PUBLIC SEW ER @ sroo M.L.10 P.:
11-sEPTic--rANK,srffpXGL pit-&R- CO.aMP. NO-
--p,TS ANO/OR DRA;NFIELD si0.00 JOB NO. I,, --X
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3,00
DA
T --SEW -0-- HN— TF
fOP NEG ADDITIONAL BLDG.OR AFF D IT r AIVER E� ENT REC RD. Z.:R
WORK TO HOUSE SEWER 2110
OVER-FLOW__ — -s—E 9 p X-G E P
DRAIN FIELD
ELL.MANHOLE @ $E-3.00
-C- -- - - HWY. OR ST.W 1 DENI NG
4 AXLT7R,REPAIR OR ABA HOUSE.
SE�EROR DISPOSAL SYSTEM $a,00
- ----- STATE ENCROACHMENT
PERMIT NO,
1 NOUSTRIAL
WASTE APPROVAL
CHARGES
Pi 00
OWNERS PERMIT 2—------ E
CONNECTION CHARGE FE
AUTHORIZATION TOTAL FEE i " i,/ -- - ----- —---- ---
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REI,M BU R5 E M..ENT FEE
TRACTOR 10 CONNECT THE ABOVE DE5CRIBED EXISTING D'NEL.LiNG
P OV
TO ECTOR'S SIGNATURE
0 THE UBLIC SEWER. APPRALS DATINSP
SIGNED THIS-----DAY
OWNER OR
NEW
HOUSE SEWER
E NT
OWNERS AG
CONNECT AD011 1ONAL
BUILDING OR WORK
1 HERESY ACKNov�� SEPTIC TANK,SEEP,PIT(S)
AND
T I HAVE. READ THIS APPLICATION AND/OR DRAINFIELD
N 5TATF. THAT THE--C.�OVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY-;:�6RWNANCUIS AND STATE LAWS RFC-Uk,'�riNG
PLUMBING AND 5F4YE:RS CESSPOOL ❑ ORYWELL
I HERFey CEYIFY THAT I AM
PROPERLY' REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS/kEQUiRKD BY LOS ANGLES -r I
C. STATE OF SEWAGE DISPOSAL SYSTEM
ABANDON HOUSE SEWER
SIGNATURE_ 1'I At,r0�;, �4NTEND TO DIS CT PLUG AND
ALIFORNIA /)R THAT I AM THE L E17AL PWD&R AND
R
95!DE iN. �kHE: Ap��VE DESCRIBED 1�0104�
OF P:-:RMrTTEE-- SEPTIC TANKS
i SEEP,PIT(S) ❑ CESSPOOL,-,
6
VALIDATIOROBERT A. WOOD
C.K. M.O. CASH SUPERVISING MECHANICAL ENGINEER
JJ