HomeMy Public PortalAbout10250 RANDWICK DR_Sewer__ T*2,rMJ3 0I IN
E806 3-6
13A6420 2 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer AD ES.
WILLIAM A. JENSEN, Supt of Building
LOCALITY
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FOR APPLICANT TO FILL IN
D E S,- 1,.D N LOT NO. IINEI
MAIL
BLOCK_ TRACT I A
P, - D
NO. OF BLDGS,
S;ZF OF LOT NOW ON LOT Tern 1 a Cir
N At . 628-18
USE OG=BU I LDINGs i d e %L tYe DISTRICT NO. GROUP MAP PROCESSED BY
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CONTRACTOf4 4, e-m efflxy- 6
ADDRESS CONNECTION DATA
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py STATION DEPTH
CITY
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MANHOLE REFERENCE UllER
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-rTATE
-lSOUNTY
No_ DESCRIPTION OF �WOIRK TYPE OP CONNECTION LENGTH FROM
'-io-sa suw' :R c-6"Eciv'q G -T�o-
Y, CURB PL, M.L.TO P.L.
JBL C SEWER @ $5.00 4
PTIC 0
- TANK SEEPAGE PIT-.— - R - '; P.C.NO:
SE
i� PtTS,AND/OR CIRAiNFIELD $1000 CO. IMP.NO. JOB.0
I HOUSE SEWERCONNECTINGT 0
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVArEC!cPC)SAI-_SYSTEM________q S3-00 0
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c 6N-NFCTXblJ rf,6 I�ja:a 066-o R -AFF!t5AViT Ajv� EASEME-4T li-CO --F?.sTWNo-- 6�6�Fi
WORK TO HOU C SEWER @ 5;3.00
-FbVCRF LOW-5-E-EPAGEFPVf,6RA�FNFiELO -1----------
i EXTN.,CESSPOOL,DRYWELL,MA NH OLE @ $5.00
ALTER.FIE PAI R OR ABANDON HOUSEWWI, OR ST.WIDENING—
-S�WCR O_ MR DISPOSAL SYSTEM $.i.00 ------
STATE ENCROACHMENT
PERMIT NO.
iNCUSTRIAL
WASTE APPROVAL
CHARGES
PERM-
OWNER7S--1 IT 21 00
CHARGE FEE
AUTHORIZATION I TOTAL FEE CONNECTION
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMSURSEMEN'I FEE
T RAC7 TO CONNECT THE ASOVr DESCRIBED EXISTING DWELLING
DATE I N6PECTOR'5 SIGNATURE
OR -------
TO THE: PUBLIC SEWER. APPR&VA:CS
SIGNED THIS._ DAY
OWNER OrNEW HOUSE SEWER
OWNERS AGENT—— e IN
CONNECT ADDITIONAL
SUILDI NG OR WORK
ADDRESS
SEPTIC TANK.SEEP,Pfr(s)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIRo
AND
LSTATE THAT THE ABCVF IS CoRRPCr' AND AGREE TO COM LY
WITH
.ALL COUNTY."ORG E LAWS REGULATING
PLUMBING AND SEWERS,"t.PCk.NeFS AND STAT CESSPOOL DRYWELL ❑
HEREBY CFFfTIF-Y'THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.5EWER-ow
LI CENSED Af�"'RF�I`WR FE) 13Y LOS ANILES COUNTY AND sTA�m OF SEWAGE DISPOSAL SYSTEM
C ALIFOQNIA,'OR'THAT 1 AM THE LEGAL OWN",OF, AND IN�ENO TO
DISCONNECT PLUG AND
RESIDE
.'y,jE DESCRIBED RESUU Al. PROPERTY.
A13ANDON HOUSE SEWER i
SIGNATURIC —------
OF PERMITTEE---—____� CKFILL SEPTIC TANKS
-4 SEEP.PIT(S) ❑ CESSPOOLS rj
ROBERT A. WOOD
K. SUPERVISING MECHANICAL ENGINEER
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