HomeMy Public PortalAbout5033 RYLAND AVE_Sewer__ : 64LD �
54APPLICATION FOR PER IT
:5G7
BOUNTY OF LOS ANGELES SEWER_SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE; County Engineer ACORESs
WILLIAM A. JENSEN, Supt o4 Building
LOCALITY •�J �.,_,
NEAREST
-- -'. -FOR APPLI ANT TO FILL IN RD55 5T c� ,_ x:� _ _-__—_-------
OWNER
___--
-
DESCRIPTION Lc,T N`�y,� -J7 � ._ + 4 OWNER
- — _ [ y —
MAIL
BLOCKTR4CT .7.J7£�.L- Pte' � $ � ADURE55
NO. OF SLOG S. 7'
SIZE OF LOT NOW ON LOT' -= CkTY TEC.. NO.
USE OF f
BUILDINGS -':� DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACT
ADDRESS CONNECTION DATA
9 r
CITY "� TELA. 7 mr' f !' _. , EPTH ,
T� E -_
j; .Y;:r- SYRT.. MANHOLE REFI= ��
REGISTRATION NO. z,a COUNTY �1 LOWER
NO. DESCRtPTtON Or WORK FEF•' '''TYPE O fION LENr TIi PO'M >.
HOUSE SEWER CONNEFIG
CNTO -_- r _.- Y -P'L. M.L TO P.I_
PUBLIC SE Ne R @ $5.00
_._ PC.NO.
SEPTIC TANK.SEEPAGE PIT 6R -
1 P T_;AND'OR DRAINFIELD $}0.00 ! CO.IMP NO- r JOB NO.
_
I PRIVATE 5 SE. R SAL NES TING-Tc-
I
PERMIT NO ROAD PERMIT NO.
1V 7'
' E DISPOSAL SYSTEM ® $3.00 Y `1
1
ONNECT AOOITIONAL BLDG CR _-_ --- AFFIDAVIT -- ; EAS rMEHT RECORD INS-R.NO. DATE ~/v
WORK TO HOUSE SEWER $3.00
— _-
ER�
D TN.,CE W SEEPAGE PIT DRAINFIELD HWY. OR 57�.WIDEN I
WMVER
FXTN CE55 PDOL,D RY WEP L.MAN110E� $5.00
ALTEFF REPAIR OR AMAt�tOON HO USc_.� r______ WIDENING
_-. WER OR DISPOSAL SYSTEM @ $ -STATE-E _ROACH..ME_N _
_
PERMI
NO.
INDUSTRIAL.
—t.
`.JANE APPROVAL
______-__.._ _ __2 _0_0____ - - . R 'S
OWNER`S PERMIT B zI o® __CHARGES---- ----- ----- - -���--- CONNECTION CHARGE FEE
AUTHORIZATIONT®TAL FEE
! HAVE AT 'rWS DATE A CONTRACT WITH THE HEREIN.NAMED CON- REIMBURSEMENT FEE
TRACTQR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING p_
TOTHE PURLI- SEWER. — APPROVALS - DATE IN5PEC7,t?SSIGNft"URE
SIGNED THIS—_DAY
OWNFR OR °
. �, , NEW HOUSE SEWER -
OWNERS AGENT___.__ '/ --._- __.____-___ _.
-� CONNECT ADDITIONAL
ADORE S
BUILDING OR_WORK ��'
_ --_ ._-.___-..
AND 5F.ATE T'HAF THE ABOVE 18 CORRECT AND AGREE 'TO COMPLY
-- - - -� -�- ---- _ SEPTIC TANK,SEEP PIT45
1 +i FREBY ACK IOWLEDGE THAT t HAVE READ THIS APPLILF'
AT;ON AND/ORDRAINfEL- I
VV
:TH ALI.. COUNTY ORDINANCES AND STATE LAWS REGULATING
RLU?k RING AND SEWERS CESSPOOL LI DRYWELL [I
_-_ _ ___._.
7
HEREBY CERTIFY THAT ) AM PROPERLY REGISTERED AND�OR ALTER,REPAt R.SEWER OR 1
L;CEN
AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE"DISPOSAL.SYSTEM � I
RFSiFORNLA OR THAT AM,7HE LEGAL OWNER OF_ ND INTEND TO TISEO -ECT PLU'-_" '-`--_S_�-`-"------
' D15CO.N^.EC7' PLUG NO
REStD'£ iN', THE AB•7Y'f DE:S I:RIBED RE,S'IDENTIAL. PROPERTY.
,
r ABANDON HOUSE EWER
SIGNATURE S'Y _ .'`; .;,y .,r -- .-.. _ ...____
OF PERMITTEE = Y '�" ?l J "„"�- HACKFI LL SEPTIC TANKS
'- - - - --- SEEP,P T(S) CESSPOOLS
VALIDATION ROBERT A. WOOD
CK, M.O. CASH SUPERVISING MECHANICAL ENGINEER
7GAG42
7 D
A642..E2 APPLICA110N FOO PERMIT
1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BuILDING
IOI$SS A. LANIBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt at Building --- - -- — -- —LOCALITY
NEAREST ✓.Y ✓
FOR APPLICANT TO SILL IN --RQ S'S ST 4 - -
LEGALg�� -
DESCRIP'TION LOT NO � t J N6'R
BLO_K ^;: a ,�+ AIL _.._-
F. �p FRA.C.7 �ti ...'--y J y, DDRE55
NO OF BLOGS. -. _.. _-
SIZE O LOT NOW ON LOT / CITY TEL. NO.
__-_ _._
USE OF
BILI LDI NGS _- DISTRICT NO. GROUP. MAP PROCESSED BY
_ - _.- _..__ .--c _._-_- ..- -_- -. - BK PG
CONTRACTOR
ADDRESS J• / - A,--_ CONNECTION DATA
-- ,
CITY �xi fj,:-*-_ .. _TEL �i'"`=_ 'l �d -� `•-._ Si`A—ION g _1�EP H__
bT'AYE MXNHOLE REF Na
Ctq
R£GI 7RATION NE ,f_ '� �- COUNTY x _,OWER _
NO. DESCRY P7tON OF WORK FEC TYPE,OF, NPCT ION LENGTH RRCI.M '
HQ SF SEWER CONNECTING TO P,L.
PUBLIC SEWER @ $5.0/J f -�-"-`-.:•'- –""� _ ._..-- ___�. — __—_ - __ 3^
—.– _. __. Y C.NO v
v
SEPTIC TANK(,SF_EPAGF PIT OR 1--�---- -
7eiC,0O CO.EMP NO, JOB NO
PITS AND AOR DRAT NFIELD C _ - x
OUSE 5 K FNY'CT!NG E 3 �
TRUNK YJK PERMIT NO ROAD PERMIT NO.- O
Prr14A fE:.D SPO A.L 5Y5TEM � 83-00 r �
CONN
WORK TO ADDU TiOVAL BLDG OR AFFfDAVft WASYER EASEMENT RECOfiD INSTR.NO- DATE tl
I
WORK TO HOUSE SEWER @ $3,00
OVERFLOW SEEPAGE
t XTN,.CESSE COL..DRYWE'LL.MANHOLE 0 '$5.00 ! HWY.DR SF.WIDENING
_..
ALTER,REP AjR OR ABANISON HOUSE - '
"J S WFr c;El'L?tSPOSAL 1',STE M. $.i'00
y-`` ----,. STATE ENCROACHMENT
'�r d t I %. PERMIT NO..
_t.._�„.._ INDUSTRIAL
i WASTE APPROVAL--
OWNER°S PERMIT
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IJ r
IHAVE Al THIS DATE A CONTRACT WITH THE HER ;N NAMED CON” RCIMB RS_E,MENT FEET RACTGR TO CONNECT THE ABOVE DECSR BE'-D EXISTING: DWELLING -------- ---- -----------
TO THE PUBLIC SEWER. APPROVALS DATE. �INSPECTORS SIGNATURE
SIGNED 'PHIS.------DAY DE ---------- ------"�-----�_ — i- ---- --- ----
OWNER OR .."✓ r„ ✓'� NEW OWNERS AGEN'T_-.-__ HOUSE SEWER
OWN
CONNECT ADDITIONAL
ADDRESS ®iTILDI N'G.OR WORK
--_ _ _ -_ --.- ....-, _
d HEN B! ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELO
AND
STATE THAT '.HE ABOVE. IS CORRECT AND AGREE TO COMPLY
W!rH ALL COUNTY ORWNANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL. (_� DEtYW ELL
I HEREBY CERTSFY- THAT I AM PROPERLY REGISTF_REO AND/OR ALTER.REPAIR,SEWER
,LICENSED A9 REQUIRED_-BY LOS ANGLES COUNTY. AND STATE 01=' SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA7,-E'AM1THE LEGAL OWNER Oki'AND INTEND TO _._— - _.._�__.____.-_
RESIDE IN, THE VE 01tSCRISFD RpSiF
.DFNT)AL/;�ssR'OPERTY. ABANDON HOUSE SEWER
1 ✓,C
i
S i.GNA.IiRE. (�J z � 7" /
OF FERM'fT7E `- BAC KP'ILL SEA'YIC TANKS El
_.------_ _ __L'__ ____ SEEP,PITS) is CESSPOOLS p.
VALIDATION,,,,,, ROBERT A. WOOD
CK. 111.O CASE�!
S:.1PERVISING MECHANICAL.. ENGINEER
- 1