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HomeMy Public PortalAbout10244 RANDWICK DR_Sewer__ Tr,pLm CITT �IE808 3- Z 76AG4ZOCAPPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION County Engineer JOHN A. LAMB1E A,GEjp244- 3. R-and-wick 1r ., WILLIAM A. JENSEk ---, �1. 1, e y Supt of Building T. T.- I LOCAL- Y� N m E A RE" FOR APPLICANT TO FILL IN CRg55 5T. DESCRIPTION_ LOT NO. OWNEFJkjaber Da MAIL nmm�— JT. _BLOC-K -TRACT ADORES 5926 1 NO. OF SLOGS. p SIZE OF I-OT NOW ON LOT CITY TEL" NO. USE 0'10 BUiLDIN idence DISTRICT NO, GROUT'] BK MAP PROCESSED BY PG CONTRA tgnr ADORE 13-" CONNECTION_DATA_]__ CITY At 0-4?92 STATION ___DEPTH -so U u PRER MANHOLE REFERENCE REGISTR)210;N52'5 STATE COUNT, -ECT -N'NECTtON NO. 1 DESCRIPTION OF WORK TYPE OF LENGTH FROM HOUSE S ,6N ECTING TO Y. CURB P.L., M.L.TO PL. > PUBLIC SEWER @ $5.00- P.C.NO. T SEP"TiC TANK.SEEPAGE Pre OR­------- CO.t M P,NO. j 0 B h0 PITS AND/OR DRkINFIELD @ 510.00 F40USE SIEWERCONNECTING TO TRUNK PERMIT NO, ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ S3.00 WMVIER 7 CONNECTAD61-17-f&NAL EILDI:i-OR -AIFFIDA'VIT REC&Rb. J. WORK 70 HOUSE SEWER @ $3.00 ll ov LRiF,:6,Ws`Ec PA.G r P R-Am N F NE L D EXTN CESSPOOL.DRYWELL,MANHOLE @ 55.00 I_AC HWY.OF?ST.WIDENING YE R,RFf AIR OR ABANDON HF6USE-­­­ SEWER OR DISPOSAL SYSTEM @ S3.00 - ------ STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OVMER7,s---j-PERMIT -S, 2' 00 _-- ...... CHARGES CHARGE FEE AUTHORIZATION I TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COSF � �N- REi MURSEMIENTEE TRACTOR 10 1-ONNECT THE ABOVE DESCRIBED EXISTING DWELLING 0 THE PUBLIC SEWER. APPROVALS T_ P DATE I INSPECTOR'$SIGNATURE S I G N E D TH I S--DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGENT-------,--, CONNECT ADO:TIONAL BUILDING OR W IRNA ADC SEPTIC TANK.SEEP,-PIT(S) I iHEREBY ACKNOWLEDGE THAI' I HAVE READ THIS APPLICATION AND/OR[>RAINFiELD ANDSTATE THAI' E COMPLY - THL ABOVIS CORRECT AND AGREE TO WIT H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING T, PLU ME!NO AND SEW r RS. CESSPOOL [I DRYWELL HEREBY CERTIFN j-HAr I AM PROPERLY REGISTEREry, AND/OR ALTER.,REPAIR,SEWER OR LT CENSED AS REQUIPED, BY I-CIS ANG L OUNTY ANII,'STATF OF SEWAGE DISP05AL SYSTEM ALiF CIRNIA OR1,T)"'XT I AM THE LEGAL. NER CT.O. DISC&NNIECT PLUCEWAND RE BED R ENTIA4; PROPERTY. ABANDON HOUSE R ,SIDE IN, Tfit ABOVE DESCRIBED R SiGNATURE/ El OF FE"rTTEEBACLL KFISEPTIC TANKS SFEP-PIT,S) L.I CESSPOOLS Qi I VALMATIOPI-1.1 ROBERT A. M 000 /K. M.n. SUPERVISING MECHANICAL ENGINEER