HomeMy Public PortalAbout5428 RYLAND AVE_Sewer__ APPLICATION FOR P
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL I
DEPARTMENT OF COUNTY ENGINEER
BUILDING ARID SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS - _ y��
COLEMAN W. JENKINS. SUPT" OF BUILDING / li
LOCALITY,/ - -'' ` �. v _
NEAREST F
R APPLICANT TO FILL IN CROSS ST. 2-t tP
fPRiNT OR TYPE ONL.Yi
LEGAL. + /d /
DESCRIPTION_- LOT NO_.___ OWNER_ i+.. [` ,. `,�,.�' '" �
MAIL ,:b '�-/--r-y�--
BLOCK TRACT -_- '-_ ADDRESS �J
NO. OF BLDGS. _ ._ _ ;„�, -/ •/V y°
SIZE OF LOT NOW ON !_OT CITY I TEL< NO.BUILDINGS 015TRICT NO. GROkJP CL SS MAPPROCESSED BY
8K P8
EONTRACTOR 1
J, y
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL. NO.
STATE
--.- -_.-_ LIC
LICENSE NO: GLASS MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE _ TYPE OF CO—MON LENG'T H.f+R6 N1 '—
HOUSE SEWER CONNECTING TO Y. CURB - ._,L. M.y,.-TZJ P.L.
F _
PUBLIC SEWER $5.00
..�__ ___._-_ _ ..__._ ____----__ NO.
SEPTIC FANK,SEEPAGE_PIT OR
ICO.IMP,NO. / .RT$NO
PITS AND OR DRAINCIELD $i0.00 -
-HOUSE 5EWER CONNECTING TO
TRUNK PERMIT NO -" ROAD PERMIT'-N,O.
PRIVATE Ja7E DISW 65AL SYSTEM $3.00 - - --- _
�CONNECT ADDITipNAL BLDG OR AFFIDAVIT WAIYEAT iA^t MYNT RECORD.INSTR.NO�^DATE
VJORK TO HOUSE SEWER $3.00
---iii777------ ---_ HOUSE .. 00 -_
OVERFLOW SEEPAGE P!T. DRAIN FIELD
EXTN.CES5POOL.ORYWEL L,MANHO LE @ $5.00
rr ALTErZ,REWAtR-NIR ABA------N.HOUSE - -- HWY. OR ST.WIDENING _ ----- O
! . -. .-_--.--__
I CW£ft OR D�SP@SAt SYSTEM � $3.00 _
f y STATE-_- ENCROACHMENT_ --___-__-_ _ C✓�
- - PERMIT NO. LU
INDUSTRIAL
Xyy g 1 WASTE APPROVAL Z
{- CHARGES
OWNERS PERMIT - �!- -a oo -------- ---— --- -
AUTHORIZATION TOTAL. FEE CONNECTION CHARGE FEE
>r
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED`CON- RE!MBIJRSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -- -
TO THE PUBLIC SEWER. APPROVALS RATE`T!NSPECTOR 5 SIG NATURE
SIGNED THIS DAY OF__ 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT -f-
-- CONNECT ADDITIONAL
BUILDING OR WORK
-_- -`_�_. ...- ----- 5EPT!C TANK,SEEP,PITS) I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION gNLlOR 6RAINPIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY --- - -t-- ----- �--''' --WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSP-00L DRYWELL
HEREBY CERTIFY THAT i AM PROPERLY REG!STEREO AND/OR A Tl R,,REPAIR.SEWER
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL_SYSTEM
CA I_iFORNiA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO p15
N
C ONECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABAND N HOUSE SEWER i
SIGNATURE i
OF PERM,rTEE _,_ '' ✓ ' ,-%; ,� BA,.KF!._�SEPTIC TANKS ❑
-- - ---- -- SEEP,PITiS) [] CESSPOOLS ❑
VALIDATIZ:A.:H�/
, JACK R. ALLEN
CK. M.O. SUPERVISING MECHANICAL ENGINEER