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Home My Public Portal About10240 RANDWICK DR_Sewer__ T CIS :EA(5420 a 'SAaaaD APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER---SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, Country Engineer ADDRESS WILLIAM A. IENSEN, Sup'1 of Building I EAREST 'pj FOR APPLICANT TO FILL IN S)ESCR I PCF i ON LOT NO. OWNER MAIL BLOCK RACT 27309 5"a NO. OF �l�a co.._S�em Cl 3r .:L?I V _*y-_ 5'LE OF LOT NOW ON LOT C(TY TEL. NO,a11-1y. tl E OF By LGINC �y ^�.�ry�g a O ry PROCESSED BY - p1S7RiC7 NO GRA?AP PRO B cGNrRAcionry B. Vtr� - _ , y ':- , J `-:r sem' "(' ; - ADDRESS - 4,5 NAve ,N. Ivar A CONNECTION DATA CITY '3� • f. LT STATION r' ",� L.aTH r ✓� STATE MAN44O1REFER NCE n UPP P RES;ISRI rs COUNTY �; NO.� N OF WORk FEE TYPE O CU'NNF_CTIONLEN TH FROM �.. i- HOUSE-SEWER CONNECTING TO - --- --- � �.- Y LRB "P L M.L TOP- F PUBL SEWER -N $5.00 -,� __� yyf P.C.NO a g r SANK SEEPAGE PIT OR G©NO PITS AND OR DRAiNF'iELD @ $10.00 i I Co. I MF_NC _.__. -. _ HOUSE 5EWR ONNF T1tJG.T,>.- -- r—_ TRUNK PERMIT NO ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 I CON NEC'"ADGt} ONA BLDG OR � ---^ AFFIDAVIT j YlAIV[k [AS ENF.N� "R ECORG. !NSTR.NO_r- DAYS - WORK TO HOUSE SEWER $3.00 -t- _. .._ __ OVCfi¢LOW SEKf A:.>f:p!T GRAINFIELD I EX Th.CF. SPOOL CR WELi_.MANHOLE C�? $4.00 I _-- .L -� HWY,OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ . _—.-__ _.____.__..__-_._.___._____.__.___._-_....__._.-__;--_-__ .�.__-___ STATE ENCROACHMENT PERMP r NO. -F-_--_—�---.- 7NDiJ5?RIp.L i- � ---- WAS-TE APPRO_V-AL OWNERS PERMIT _--- c-H-A—RC-ES z Om .____-�.-------- — ----------- �y.�q� �yry rp.� ---_._-. ._..-FEE- HAVE ._-__--____..-- ----1- +- _....- AUTHORIZATION[--TO- TOTAL FEE Y l CONPdE TtGN CHARGE FEE REIMBURSEMENT FEF". ! HAVE AT THIS DATE A CONTRACT WITH THE HEREIN M^cD CON- .----- ------------- TRACTOR TO CONNECT THE .ABOVE DESCRIBED EXISTING DWELLING +_ O THE Psi BL.I.. SEWER, APPROVALS li DATE j INSPECTOR'S SIGNATURE SIGNED THiS DAY OF_.. t9--_ - ------------._._'.-- ---- --- ------�__.-----. OWNER CFC NEW HOUSE SEWER '' } OWNERS A�E.NT'-,_..._ ... -'---'-'—�' - CONNECT ADDITIONAL SUlLNDiG OR WORK .4f.7 DRE 5S --.__ EPTIe TANK: SEEP,P!T!S} I. I HEREBY ACKNOWLEDGE THAT i HAVE. READ THIS APPLICATION AND,OR.ii�ftA.N.'�iF..f..D AND SATE THAT HE AS CORRECT AND AGREE TO COMPLY - _.--- __._: _Y.__�__._. W t71-i ALL COI,Pd Y OPZb3'�NA NEES AND STATE LAWS REGULATING >' CESSPOOL. (_] DRYWELL P I J H ERE CC ZT F6', T _W c �Y THAT AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR L'cNSED AS RI'_9UIREG,.BY LOS ANGLF._S COUNTY AND' STATE OF SEWAGE DISPOSAL SYSTEM I CALIFORNIA yYR-THAT' J,AM THE LEGAL-OWNER OF, AND INTEND TO - -- I`'-- "_ -"""-- - --- PE DE IN,�aii£i ABOVE: DESCRISED ,k EJ91DENTIAL PR,PERTY. DISC OHNE i PLL AND r J' ABANDON HOUSE SEWER SIGNATURE ' _ �F '� �f pA.KE!L SEPTIf,TANKS __.-- OF PERtAtYT£4, _.-e'` r4`.--=►-��- SEEP,PI7l_:I ❑ CE55PrJOLS. [J! VALIDATI0 ROBERT A. WOOD K. M.O. CASH SUPERVISING MECHANICAL ENGINEER C '! �° y .