HomeMy Public PortalAbout10243 RANDWICK DR_Sewer__ :E808 3-62
7egfi 42D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F0-
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JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN. Sup't of Building -------
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R APPLICANT' TO FILL IN .ROSS ST ? A4
LOf'NO. OWNER
- M I LTRACT6Y ADDRESS `1 J IN BLDGS. tl
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USE OF - J
BU.ILDING.S--�+€ a .DISTRICT NO. GROtJpJ MAP PROCESSED BY
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ADDRESS sy s ` CONNECTION DATA '.
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ST AT ON J' �.- DEPTH
CITY EJE-� -- 'k; I r�FFFt
ll__:: STATE. MANHOLE REFERENCE3� 't.=`.� � � res r
REGI TNRYf D_ _ _ -.,lvi?k1CLq,
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NJN I DESCRIPTION OF WORK PEE J TYPEOF CONNECT„ON LENGTH FROM
_— _- -
.eL�HOUSE SEWER TONNE TING TO _ - T- Y CURB Y L M.L.TO P.L.
PIUBLIC SEWER $500
..__.-. __ -_ __- --.- -.'_+ ---.. P
SEPTIC TANK,SEEPAGE PIT OR i CO. IMP NO. 3 '0
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PITS AND/OR DRAINFIELD � $70:00 OB NO
HOJSF SEWER CONNECTING TO I TRUNK PERMIT NO - ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM EM $3.00
CONNECT ADDITIONAL BLDG.O}2 AFPTDAVlT I N'Ai.YER -EAuf.M[Ni REC7RD.;NS7R.N0. � DATE
WORK TO HOUSE SEWER $3.00
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OVERFLOW SEEPAGE PIT.DRA NFIELD -- --� - --�
EXTN,CES5POOL,bt+Y WELL.MANHOLE 0 $54.00
ALTER,REPAIR OR ABANDON HOUSE HWY.0R ST.W;DENiNv
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_— $3.00
SEWER OR DISPOSA[.SYS
T'E N. S7AYE t:t,ICROACYi MENT
_ _�_ STATL ,'NO. -
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mcwsrRiAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT oo -. -- -- - -- - - --- - --------
--�- -- - -- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
H. .AT THIS DATE A CONTRACT WITH THE HEREIN N)(MED CON RE[M4'J RSEME_NT FEE
'rR.ACTOR TGC ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLI "EWER. APPROVALS _ INSPECTOR'S THIS
---- '—._--
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OWNER OR, NEW HOUSE SEWER
OWNERS CONNECT ADDITIONAL�- r--
BLJIL.DINC OR WORK !
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...J - _.<'____ SEPTIC TANK,SEEP,F'iT FSj �
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I HEREDY ACKNWLEDGE THAT J kiAVE READ THIS APPLE A_ION --
AND STATE THAT THE ABOVE I$"CORRECT AND AGRFE TO COMPLY AND/OR�k'AINFI .LD
WITHALI. COUNTY O%i'b INAN*eES"AND STATE LAWS REGULATING
FLU MH.!NG AND 3EWIERS ' CLSSP00 ❑ DRYWELL
I
'HEREBY CERTIP'` THAT CAM PROPERLY REGISTERED ANDi OR ALTER, REPAIR„SEWER OR
L.I(TENSED AS REOVIRE BY LOS ANGLES COUNTY--a AND STATE OF SEWAGE DISPOSAL STEM i I
CAL,'r ORNtA ORS THAT JAM THE LEGAL OWNER OPr AN iN'i'END TO --- -' -'- - --- ---- - - ---- "---
° DI SCONN 7 PLUG AND
RESIDE .N, TI-1.4E, ABOV DESti ED RES!DENT IA% ROPERTY
� Y ABANDON HOUSE SEWER
SIGNATURE ,(/ r yp�yw,. BACKFILL SEPTIC,7ANK5.
OF PERMITTEE.-_ -� —_ 5 PIT t S) LI CESSPOOLS ❑'
VA DATIO ROBERT A. WOOD
CK. M.o CASH SUPERVISING MECHANICAL ENGINEER
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