HomeMy Public PortalAbout10249 RANDWICK DR_Sewer__ 16`'64
/'6 A.S.12D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FI�111Nc
JOHN A. LAMBIE. County Engineer ORFss ��}° ��—_�� �?1t��lt �� �
WILLIAM A. IENSEN, Sup't of Building ;] [)
CAL ITL Tempe CitrdARES ..i,-F,t..at .+"+Jrt�✓IF
,y
FOR APPLICANT TO FILL IN CROSS ST
LEGAL
DESL R IRT I ON_-.___LOT NO. OWNER .£. ``��yy-----,-_
BLOCK TRACT t � ADDRMA)LES.S592
6 N. .�eMple C-I tT I�J���>i
SIZE OF LOi' NOW OFBLDLO CITY File, " ;� ..jNO. A, .
';4 E O F ';y t�, { y�
BUILDINGS •qe "`mess msTRiCY NO" GROUP ASAPPROCESSED BY
SK PC
CONT RACTOR:�,�
ADDRESS a c Y CONNECTION DATA r
---- .�-,"-��.y-.t.� �ry�„�y��g `'7V' ¢- ,Ty--- ---- -. --- -- --- — — --- --
-TY 6te Ssbri .$ L !�!-4772 STATi Q'Va DEPTH-
✓`g a}(.�iy ❑ STATE MANHOLE RFFLRE14CE -. / �UPPER
RE_C!STRAT,0 ijV4'52 _ .__'___.__-_.___ _�`J_ COLNTY �� �� .f7 �
NO. '- DESCftIPTIDN diF 1 okk FEE --- _ I = .4Vrtest^
_ ____ - �. _. M _
TYPE CSF COh NECT[bN EN 7H SRO
�HOUSE SEWER CONNECTING 70 ,y.v-I Y. CURB //'p L rM._TO P.L.
PUBLIC SEWER @ $5.00
__ -. - PC.NO
EPTIC:TANK,.SEEPAGE PiT OR
CO. IMP NO. JOB NO
PI rS AND/OR ORAI NFIELd @ $10.00
_-_"___-_
HOUSE SEWER r_ONNECTING TO }-----_
J PRIVATE D SPOSAL 5YSTEM "Cs
$3.00' TRUNK PERMIT NO. ROAD PERMIT NO. �.
CONNECT ADDITIQNA s'3LDC, 06t AF'F!DAVIT WAIVER EASEMENT i RECORd ihS-'R NO.. r DATE
! WORK TO HOUSE SEWER @ $3.00.
OYLRFLO v4 SEEPAGC•PIT DRAIh.'.6.LD
EXfN CESSPOOL,CRYWEL L.M4NHQLE� $4.00
:- __--._ - __. _ _ HWY.OR ST.WIDENING
AL1E...kf AIR OR ABANDON HOUSE -
St WER OR DISPOSAL SYSTEM L
_..._.__...1-____"_ S,'A7'E EAi:.R�ACHENT .
$3.00 I
PERMi'T NO. M
INDUSTRIAL
WASTE,APPROVAL
OWNERS PERMIT z. 00 ------ -- ----- — -----^�---
- -------- -- rt --
_ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE --- - - --- - -------- --------- --
I HAVE AT THIS DATE .A CONTRACT WITH TETE HEREIN NAMED CON, F2EiMHU RSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST;NG DWELLING _.______ �p /'qty- --.-__--_i__-____-__I.
_ i9_____ APPRO PALS —_ DATE ! INSPECTOR'S S'GNATURE
TO THE PUBLit SEWER. I
SIGNED THIS DAY OF---- ------- ----- - -------I� -- -- ---
OWNERnc.w NEW HOUSES WEE
OWNERS AGENT------_
CONNECT ADDITIONAL,
ADDRESS BUILDING OR WORK ONU." -
TANK Si_ P!T(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AIVI OR PRA1N'`IF'IkL73 '
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY -- --
}LITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING., j
PLUMRINC AND 9JEWrRS. CESSPOOL ❑ ORYWELL [�
i
I
i HERE-BY !'ERTIIV"THAt I AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR T
LtCENSE:D A5,AZ F,.L�U iRED%ABY" LOS Afa GLES COUN7Y AND S'CATE OE SEWAGE LS IS POSAL SYSTEM
E ,I ' =
DISCONNECT PLUG AN
CA_4FGRPIA .dRTHAT 7 AM THE LEGAL OWNER OPAho p{TENO TO d
PIES,DE IN eTiF ABOVE DESCRIBED RE51D4 rIAL PROPERTY. ABANDON"OUSE;SEWER
SIGNATU7 -
--
OF � BA-.PFILL SEPr!C rANKS
SEE .
NT(S) L_i CESSPOOLS ❑I
{
ALIDATIO ROBERT A. WOOD
(�3 C, M.Q. C ± SUPERVISING MECHANICAL ENGINEER
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