HomeMy Public PortalAbout5025 RYLAND AVE_Sewer__ DEPARirTREM W OF COUNTY ENGINEER SEWER®SEWAGE DISPOSAL
DIVISION OF BUILDING ,AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
D
OR APPLI ANT T FIL 77
IN LOCALITY ,
BUILDING NEAREST J
ADORE 0A AT Ae , —ROSS ST. �S�J
LOCALITY ! DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST ,��' ✓ A S-
CROSS ST. ' � i dil' ;�- a 7 1.19) Ready for Inspection DATE IS UED
_ L
OWNER s � Z/// l
MAILUSE Z09V- OCCUPANCY . #Aim
ADDRESS��� BKS PG
CITY re TEL.NO. 70
CONTRACTOR CO.IMP.NO. /3
ADDRESS JOB NO.
CITY - TEL.NO. TRUNK PERMIT N0. j fy
REGISTRATION N0. ® STATE
COUNTY ROAD PERMIT NO.
LEGALf D� y STATE ENCROACHMENT
DESCRIPTION LOT N0. l^� PERMIT NO.
BLOCK TRACT / ��z, INDUSTRIAL
WASTE APPROVAL
512E OF LOT& N0.OF BLDGB. CHAR S
NOW ON LOT
BUILUSE DING8 ( �/(7/r �fiD'� �-[�-�/�. CONNECTION CHAR FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
-HOUSE
@ $ 3.50 D RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / EXCEP7 ON RECORDED
WORK TO HOUSE SEWER 1.00 N0. I \DATE IBY
ALTER OR REPAIR EXISTING `1
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,PITS AND/OR DRAT FIELD OR 2.00 DEPTH
CESSPOOL—DRYWELL STATION / IDs el
SPECIAL CONDITIONS ONLY 2.002v MHOLE REFERENCE LOWER
TYPE OF ECTION LENGTH FROM
OWNERS PERMIT ; 1 00 c R , _ M.L.TO P.L. V V
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER• �y
SIGNED THIS_�—bEDAY OF..._ _-_ _'_ _..19y' NEW HOUSE SEWER y�
OWNER OR ,D� � CONNECT ADDITIONAL
.J).W,�FQg�•`-^G�"�T.... BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS..._...... ._....-._..-._..........----------......-----------_.._...---------- ' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR D
LICENSED AS REQUIRED BY LOS ANGELES 'COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- .
ER OF.THE ABOVE D SCRIBED RES NTIAL PROPERTY. BACKFILL SEPTIC TANKS[] _
Y @ � BEEP.PIT(8) CESSPOOLS
SIGNATURE
NM [
OF PERMITTEE.. ._... + .._.._�. ............� ,1
76A642A 663 7/53 �.f�