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HomeMy Public PortalAbout10253 RANDWICK DR_Sewer__ E808 3.62 j • 6A6421) APPLICATION FOR PERMIT •.;� ]�� COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL k DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FEAREST G _ JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 5� �{ `'/ f COLEMAN W. JENKINS. SUPT. OF BUILDING +� — — FOR APPLICANT TO FILL IN EE—___ _.._—LEGAL DESCRIPTION- MAIL ,+ BLOCK TRACT ,I ADDRESS € = " a� A NO. OFc BLDGS. SIZE OF LOS.} -f C..' NOW ON LOT CITY �Y+qa TFy._ O USE OF �— Y BUILDINGS t' a D ISTRICT NO. OUP MAP PRO SS ¢_B 2 '� A`,Y.. ,wi"/A'`J�. a- ,-yi ' BK °�dCONTRACTO j } ;� �--ADDRESS ,. +�,.- ( - - CONNECTION DATA �i't, ' '7 ' T`E�NO. 1, '�/ DEPTH CITY' - ,L __STATE �. tIC �:;:--ti REFERENCE UPPER ttCENSE NO> t' l CLA55 %*! tf LOWER NO. �! .DESCRIPTION DF WORK FEEE OF CgNNECTION LENGTH PROM1 HOUSC SEWER.CONNECTING TO CURB P:L. M,L.TO P.L. PUBLIC SEWER @ $5.00 9RSEPTIC TANK,SEEPAGE PIT OR P.G.NO. !JPITS AND OR DRAiNF1ELD Q $10.00N O._ — JOB NO.HOUSE SEWER I ONNECTING TO— (PRIVATE DISPOSAL SYSTEM � $5.00 IERMIT NO.. ROAD PERMIT NO. 0 LON NEC7 ADDITIONAL BLDG REC OR .=-� AFFIDAVIT wAivER €ASEM€HT ORD.INSTft.NO. DATE .. WORK TO HOUSE SEWER _. _.@ $3.0�0 : OVERFLOW SEEPAGE PIT.DRAINFIELD I I I y LIE N.CESSPOOL.DRYWELL..MANHOLE @ $5.00 ! ALTER REPAIR OR ABANDON HOUSE I HWY OR ST WIDENING I SEWER OR D S OSAL SYSTEM $3.00 STATE ENCROACHMENT tt) PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT _ _2 00 —t— - CONNECTION CHARGE FEE AUTHORIZATION I HAVE AT 'THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR '70 CONNECT TH�g ABOVE DESCRIBED EXISTING DWELLING_ ----- TO THE PUBLIC li,&WER �_ 6- APPROVALS �_ DATE i INSPECTOR'S SIGNATURE SIGNED THIS L- DAY- ^-3-- � -- OWNER OR ° NEW HOUSE SEWER OWNERSAGE _— CONNECT ADDITIONAL BUILDING.OR WORK I ADDRESS 5EPTlC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTAF'Y THAT I AM P,$#. RLY REG15 RED AND/OR ALTER.REPAIR,SEWER OR LICENSED AS R OU7RE0 BY LOS"^,6. COCI'NTY ND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA O 7hi'A7,f AM THE LEGAL WNER''q F, D INTEND TO DISCONNECT PLUG AND RESIDE IN TH Z0 E DESCRIBED RE pENTiA P OPERTY. ABANDON HOUSE SEWER SIGNATURE d'' �`':. ✓, jd BACKFILL SEPTIC TANKS © i OF PER TI ----- SEEP,PIT(S) ❑ CESSPOOLS ❑ VAL TION JACK R. ALLEN " `"- o. CASH SUPERVISING MECHANICAL ENGINEER u 34 OCT 3 cs D 5.0 0 T Y sng -E2 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SE WAIGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION EUI LD?NG JOHN A. LAMBIE: County Engineer ADADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALI— NE AR'FS' Glielm FOR APPLICANT TO FILL IN -A, R ION LCT NO c"NE W F MAIL I 6C'.{ YRA"T Jog A00RESS yc t NO" 0, 0'FNBLDG� E: j 62818 -SIZ0�� LOT NLOT A UIE OF -1 ng N Gc -L _s U I L D Ave D- .. Tc, r'10 MAP PRO'-ESSFD BY PG BK CONTRAC ADDRES'S CON ECTION DATA j STATION DEPTH _G aE� el TATE t1UPPER auft C COU y MANHOLE REFE:RENCE ✓ RE'GISTRATIOStO2.520 NT FEE TYPE.OFCONNECT!0N LENGTH FROM HOUSE SEWER CONNECTING To Y. CURB eF.L. , WL TO P-L, PUBLIC s Y ERs 00 P.C-NO_ 0 TIC TANK.SEER aGE SIT OR Om NO. CO. !MP- NO. P5TS AND/OR DRAINFIELD slo.co HOUSE SEWZR CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. P-RIVATE;D!SPOSAL SY5,TEM @ $3.00 0 CONNECT ADDITIONAL.BLDG,OR 1RECC)Rn. WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT.DRAINFItLD ATN,CESPOOL,DRY WELL,MAN H 0 LE HWY, OR ST.WIDENING ALTER REPAIR OR ABANDON HOUSE SIZINER OR DISROISAL sysTEm. ...... s3.00 STAI E EN ROAC.HM.FNT E PRMIT N�, -N-D-US- -1A-L--- ITR - _WAS-,E,-.PRROVAL CHARG'S 0vvmR7s--7,ppM1T--- 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE I ' -11 i MBURS17MIENT FEE I"VE A7 THIS DATE A CC��17RACT WITH THC PERLIN N,�MFO CON- -- 11RACTOR TO CON21"IrCT ,HE ABOVE DESCRIBrr) EXisTiN,. DWELLING l0 TH3- PUSLIC SEINER. APPROVALS DATt INSPECTnR'S SiGNATU'RE SIGNED THIS—.—DAY 0 vv N E R OR NEW HOUSE SEAVER 0'IV N E 4 S A E N CONNECT ADDITIONAL ADDRESS new BUILDING OR WORK €-P7 L'TANK.SEEP.P7T(5 IHFR EBKWILGE , Y ACNOEDTHT E AI HAVQFAT) THIS APPLfCATION ANO TATE Ti4AT 'HE A130VE IS CORRECT AND AGREE TO COMPLY WITH AL.'_ COUNTY Y ORDINANCES AND STATE LAWS REGULATING FLUMBI�IG AND 5?WERS. CESSPOOL ORYWELL CI 1 HEREBY CEKt! :.Ily THAT l AM PR-OPERLY REGISTERED AND/011 ALTER,RLPAI R SEWER OR ;-ICENSED AS RZOUiRED By LOS ANGLES COUNTY, AND STATE OF SEVIAGE DISPOSAL SYSTEM CALIFORNIA r THAT 1 AR CF; AND !NTE511 TO —D;bcL,,,,iNEr;r PLUU AND R-G'DE IN, A61,?V]E AL,;ROPIE-RTY� ABANDON ;EW-, -SIG NA'TURE Or PERMITT Lt 'ANKS S--P,pi'i I L! CE53-$P0 LS_L ALMATION----,. ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER C K._ M.OQ�A.