HomeMy Public PortalAbout5024 RYLAND AVE_Sewer__ ISA642D
E-663 11-!55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
ST
FOR APPLICANT TO FILL IN doss
ST.
LEGL
DESCRAIPTJON LOT NO. ,Ij OWNER
MAIL
BLOCK TRACT I
ADDRESS
NO.OF BLDGS.
_SIZE OF LOTS NOW ON LOT CITY TEL. NO.
USE OF
DISTRICT NO, CROUP MAP
ILD114GS
BK PG
CONTRACTOR A-
CONNECTION DATA
ADDRESS
STATION DEPTH
CITY
TEL NO j
MANHOLE REFERENCE
El'-STATE LOWER
REGISTRATION NO.
COUNTY
NO. DESCRIPTION OF WORK PEE
TYPE 01
'
LENGTH FROM- -�HOU5E SEWER M
CONNECTING TO70
PUBLIC SEWER P.L.. M.L. .
L _ _ P — @
SEPTIC
PITS AND/OR DRAIN.FiELD
$3.00
RAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYW ELL,M,AN HOLE (k $2.00 (:-0. IMP NO. JOB NO
HO—USE SEWER CONNECTING TO
PRIVATE WSPOSALSYSTEI'd (a) $1.0c) TRUNK PERMIT NO. ROAD PERMIT N,,,c L/
CONNECT ADDITIONAL,BLDG.OR STATE ENCROACHMENT
WORK TO HOUSESEWER Q(' $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
1 SEWER OR DISPOSAL SYSTEM _c(v $1,00 I WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 100—-----�1.
AUTHORIZATION ji0TAL FEE REIMBURSEMENT FEE
j
I HAVE AT THIS DATE A,CONTRACT WITH CON_ APPROVALS DATE JINSPECTOR'SSIGNATUPE
�HE HEREIN "MED --—--------
TRACTOR TO CONNECT ITHE, ABOVE DESCRIBED EXISTING DWELLING,
TO THE PUBLIC SEVVV, NEW HOUSE SEWER
SIGNEDTHI DAY OF
CONNECT ADDITIONAL
OWNER OR!' J, _�ULILDING OR WORK—-----
OWNERS AGENT
PIT(S)
SEPTIC TANK.SEEP
AND/UR DRAINFIELD
1- —
HEREBY
EP
'EBY LE�DG T HAVE
A,eK E _CL READ APPLICATION CESSPOOL DRYWELLE]
AND STATE THAT THE ABOVE IS CORRECT AND ;HIS
TO COMPLY
VIITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. S-EWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATE or DISCONNECT PLUG AND
CALIFORNIA OR TRAY I AM THE LEGAL OWNER OF THE ABOVE ABAND-0-NI HOUSE-SEWER.-
DESCRIBED RESIDENTIAL PRaPERTY. BACKFILL SEPTIC TANKS Ej
SEEP, PIT(S) 0 CESSPOOLS Li
-
OWNER
"0
OF PERMITTEE
JOHN A. LAMBIE, dOUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLEIG. INSPECTOR
CK. M. G. {:CAShij