HomeMy Public PortalAbout10237 RANDWICK DR_Sewer__ teAsa76AS4 zD APPLICATION FOR PERMIT - -
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FD.
JOHN A. LAMBIE, County Engineer i
WILLIAM A. jENSEN. Bup't of Building
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R APPLICANT TOFILL IN5Tx-----LOT NO OWNER°y'' MAILTRACT ADDRESS R
NO. OF SLOGS. c�
SIZE OF LOT NOW ON LOT CITY `¢l, _ -}�:; C x,NO." -t 628 1 8
USE OF
BUILDINGS , r DISTRT NO; GROUP MAP PROCESSED BY
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CONTRACTOR��aYy'y°y B . V e I
ADDRESS -. -' Y.
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CONNECTION DATA
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�5 ..71 STATION CITY TEL NO_ T 1 �- DEPTH Y
0 COUNTY 0 STATE MANHOLE REF'k:RE VCt
REGISTRATION �
NO.
__-OF—WORK ---F _
N DESCRtPTI Otv OpRK EE TYPE QF CONNECTION',-� LENGTH FROM -4,
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'1-SOUSE 5LW ER CC1N`d ECTtNG TO T Y. CURB '. C^L,�' M.L.TO P.l..
PU BL{C CFWER -$S.00 0-- C
P.0 NO
SEPTA TANK. RAIN ,E PIT OR JOB NO "` J
- CO. IMP. NO.
PI'S ANC OR URA, NFI E.LD �1 $10.00 I -
HOUSE GWER CONNE.CTiNG TO TRUNK PERMIT NO. ROAD PERNUr NO. Inc
%IVATE DISPOSAL SYSTEM
IVP E.'7 ADD 7iOCvAL BLDG OR -AFFIDAVIT WAIVER EASEMENT RECORD.I NO �� DP.T£
WORK TO HO SF_SEWER .q1 $9.00 I _
Oy-RFLOW SEEPAGE PIT,DRAINFIELD
EXTN,CESSPOOL,DRYWELL.MANHOLE G $5.00
___�ALTER,RF PAIR OR ABANDON
_ _ .
HO(JSE_ HWY.OR ST WIDENING
STATE_-
F NER Oft D15POSAL SYSTEM
_NCft OACHMENT
>:ERMIT N.
INDUSTRIAL
I j WASTE APPROVAL
OWNERS PERMIT Oo - - - - --
CHARGES
- - - ---- -- — -- --- -
AUTHORIZATION I TOTAL FEE � CONNECTION CHARGE.FEE:
IHAVE AT THIS DATE A CONTRACTWITH THE HEREIN NAMED CON- REiM6 lRSEMENT FEE
TR ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINf; __---g_.__
1'O THE PUB L IC .SEWER. APPROVALS ---DATE INSPECTORS SIGIAATURE
SIGNED THIS DAY
OWNER
0E-----------_. - 78.- _.-._-.___ ------ -9- -._.�__._---------_.-------
OWNER OR NEW HOUSE.SEWER
OWNERS AGENT '+
CONNECT ADDITIONAL _.. ._
BUILDING OR WORK
SEP'TICTANK SEEP PITS)
HERESY N AT I HAVE READ THI APPLICATION PLICATION AVD/OR DRATNFIELD
AND TATE THAT H
TE EADH
BOVE I5 CORRECT AND AGREE TO COMPLY
H
WIT
CES AND STATE LAWS REGULATING CESSPOOL DRYWEL,L
PLUMBING AND .SEWERS
AL COU TY A
'.ERTCRY..'PRAT I' )
I HERESY AM PROPERLY REGISTERED AN�(OR ALTER,REPAIR.5EW`EF.OR
LICENSED AS R;OWRED BY LOS ANGLES f-OUp 1Y AND S'(ATE OF SWAG CI PCSAL SYSTEM.
CALIFORNIA dR TNAT 1 4M THE LEGAL DW NSR.'OF, AND IHITE NQ TO DISCONNECT PA U[ AVU - ---- .---- -
RESIDE IPI,. THE A�, VE DE9C,RIBEO RESiO$,1� b4L PROP R X.
ABANDON}{OUSE SEWER
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SIGNATURE -^`ty ,,✓ d' r - - - _ __._._-.. -__-._—_
OF PERM?TTEE. d ��fi' - .`�... `..BACKFILL SEPTIC TANKS Lr]
_ _ _ STEP.PIT IS) L! CESSPOOLS [31
ALIDATIOIC- --_. ROBERT A. WOOD
' I SUPERVISING MECHANICAL. ENGINEER
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