HomeMy Public PortalAbout10257 RANDWICK DR_Sewer__ T-Wfl"P L 3 01
76A6490 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
I U I '
JOHN A. LAMBIE, County Enr ADDRESS
gineer
WILLIAM A, JENSEN, Sup't of building
<�CALITY
NEAREST
E R
N A EST
E "'ST
CROS5 ST.Gjj 01M,an AVe
FOR APPLICANT TO FILL IN
DESCR IP�ION LOT NO. OWNER FX
M
SL _7
I
BLOCK- TRACT ADDRESS92
NO, SLOGS. -4
2 . _09 __5 ,6_ _ _ _D___e
M ---city ..R)�_Vd
SIZE OF LOT NOW ON LOT CITY C11;w—At � 82)RIP
USE
OF DISTRICT N PROCESSED By
BUILDINGS MAP
0 GROUP BK PC;
CONTR 4S
ADDRESS .'' kvwCONNECTION DATA
- .�-
CITY STA-T ON
'Joel DEPTH
0
*01- SIATE IJ'r!!a R
H MANHO
jLX REFERENCE 2F1
REGISTRATI" 25 H COUNTY
-&F
TON WORK FEE TYPE OF CO-NNECTION LENGTH FROM
NO. : S CR I PT J
OM
HOUSE PUBSEWER CONNECTING 70Y. CURB M-L,TO P.L.
'LTC SEWER 5
$ .00 z-
—
P.C.ND.SEPTIC TANK.SEEPACiE 1IT OP. JOB NO,
Co. IMP. NO.
PITS AND/OR DRAINPfELD @ $10.00
111111S T SIWIR C.INECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
,
RIVA F DISPOSAL SYSTEM @ 153
CONNIECT ADDITIONAL BLDG,OR AFFIDAVIT I WAIVER EASEMENT I RFCORD.INS TR No,
WORK TO H.01-15E SEWER 53.00
-NFIELD
6VERF�OW SEEPAGE PiT i ORAI
EXTN..(�ESSFOOi�.DRYVVLLL,MAIHC)LE @ 53,00
AL_T ff- - - - - --7 HWY DR ST,WIDENING
JR,RFPAIFf6R ASAND05N HOUSE
SEWER OR DISPOSAL SYSTEM Cm 163.00 STA'TE ENCROACHMENT
PER-MIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00
AUTHORIZATION -TOTAL FEE X CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR
ACTOR T 0 CO"'NECT THE ABOVE DESCRIBE) EX;ST.NG DWELLING
To THE PUBLIC SEWER. APPROVALS I DATE I INSPECTOR'S S:GNA rRE
SIGNED THIS
OWNEROR
.NEW HOUSE SEWER
OWNERS - A
CONNECT DDiT
iCINAL
BUILDING
0R, am
SEF'rICTANK.SEEP,PIT(5)
I Hk-RrHY AfKNOW,EOGE THAT I HAIL READ HIS APPLICA11ON AND/OR DRAINFOELD
AND STATE THAT 1HC ABOVE 15 C0RRFCT AP40 AGREE 10 COMPLY
WITHALL. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.,-,- CESSPOOL El DRYIVELL �71
I HEREBY CERTIFY.THAT I" AM PROPIERLY REGISTERED AND,/OR ALTER,REPAIR,SEWER OR
LICENSED AS RWUIRED BY LOS ANGLES COUNTY AND STATE; OF 5FWAGE DISPOSAL SY T S Em.
CALIFORNIA I AM THE AL 0 AND.INTEND TO
LEGAL
OWN DISCONNECT PLUG AND
RESIDE IN, TH19'ABOVE DESCRIB ED 5 PROPERTY�11 ABANDON HOUS
RE j I ESEWE
R
SIGNATURE
8A }{.FILL 5 PT Ir TANKS El
OF FEIRMrr�� SEEP,PIT{S?
r
z (,FSSPOOLS []I
vALID�TIO�.I�""-:, SL'P.R'IROBERT A. WOOD
CK. M. _A. SING MECHANICAL ENGINEER