HomeMy Public PortalAbout5015 RYLAND AVE_Sewer__ DEPA'T 'r ° ' °O ENanvE31B SEWER-SEWAGE DISPOSAL 1
` DIVISION, OF" BUILDING AND SAFETY PERMIT APPLICATION
_ -'COUNl'Y OF LOS "GEMS
WILLIAM I FOX, COUNTY ENGINEER I
OS
_AANG DDRDDR ESS
- FOR APPLICANT TO FILL. IN LOCALITY C
ADDRESSC?IJ` , .✓ CROSS ST. r., i. Q
LOCALITY `T- DISTRICT No. SERIAL NO. PERMIT N0: c
.CNEAESTROSS ST. O e-a6 � A �� S
R C &-a{O 1EIVED BY Ready for Inapeation ``C DA1T jE ISS ED
OWNER. f 1. Q
MAIL
ADDRESS USE ZONE 1 OCCUPANCY ° MAP -
CITY
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CITY _ TEL.NO.. �(3. a� --.� I
CONTRACTOR psfj�f+n ; �;
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CO.INIP:N0.
ADDRESS 1321 So. Montebello Blvd.
JOB.No.
! CITY UN. 1-0509EL.NO.Wntebello
TRUNK PERMIT NO.
—STATE
""� �•�
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REGISTRATION N0, 1�.��r� �f�C� ` ® COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT Or- STATE ENCROACHMENT
PERMIT N0.
BLOCK TR '� INDUSTRIAL.
WASTE:APPROVAL
SIZE.OF LOT,�� �b]� )' SOW ON LOTDTOS.-- / CHARGES
USE OF f� - -
BUILDINGS 1—t-4t - CONNE6712tCHARGE FEE
e
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT
HOUSE SEWER CONNECTING TO•
PUBLIC SEWER @ s 3.50 3sSG RECEIPT NO. �� BY
HOUSESEWER CONNECTING TO
PRIVATE:DISP.OSALSYSTEM 1:00
CONNECT ADDITIONAL BLDG.OREXCEP TION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE" BY
SEWER OR DISPOSAL SYSTEM 1.00 I
DISCONNECT AND ABANDON SEWER
u AND/OR DISPOSAL SYSTEM 1.00. CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR.DRAINFIELD 2.00 STATION �-� DEPTH r.7
CESSP.00L—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / �M�dWQ3:E,ItEFERENCE
�a �.+, tl 4�tfRPEB7 E071
TYPE OF CONNECT.j�Q�1 � LENGTH FROM
Y. CURB �P.L� M.L.TO P.L.
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE ! Al o.
1 HAVE THIS DATE CONTRACTED WITH .THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS IN8PECTOR'8SIGN TUBE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..._......__......DAY OF.... 19. 1 NEW HOUSE SEWER
OWNER. OR j CONNECT ADDITIONAL
OWNERS AGENT,e' Ql'' f BUILDING OR WORK
-
SEPTIC TANK,SEEP.PIT(S)
ADDRESS...............-__-____._..._ -Al- .
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ T1418 APPLI- CESSPOOL 0 DRYWEL'L
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
,TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY 'REGISTERED
AND LICENSED AS REQUIRED BY,LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED. RESIDENTIAL PROPERTY. BACKFILL.SEPTIC TANKS
SIGNATURE �
SEEP.PIT(S)[] CESSPOOLS . Al J
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OF PERMITTEE��k_`•^_��..,..._......... ._.._:._...,.._........e._.__.__ .
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