HomeMy Public PortalAbout5440 RYLAND AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUPT DF BUILDING ADDRESS -
FOR APPLIC, T TO Ft IN LOCALITY -
BUILDING " NEAREST
ADDRESS ` CROSS ST. `
LOCALITY ___������lllf� DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ,
MAIL } USE ZONEOCCUPANCY MAP
ADDRESS :. T q yam. BK PG
CITY {
CONTRACTOR , CHARGES REIMBURSEMENT FEE
ADDRESS
REQUIRED
j �� a3d .�
NOT REQUIRED
CITY ,p TELAOA/, ? )OB NO. _ ^I CONNECTION CHARGE FEE
STATE
REGISTRATION NO. COUNTY CO.IMP.N0.
LEGAL --'- - --- RECEIPT NO. i DATE +BY
DESCRIPTION LOT NO. j
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLOGS. RECEIPT NO. I DATE BY
NOW ON LOT
USE OF
BUILDINGS - TRUNK PERMIT NO.
NO. DESCRIPTION OF WORK FEE --
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLICSEWER @ $ 3.50 L;
— HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
_ PRIVATE DISPOSAL SYSTEM 1.00 I PERMIT NO_`
COBNECT ADDITIONAL BLDG,OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXJSTING
SEWER OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION DEPTH
SEPTIC TANK SEEPAGE PIT OR —
_�PITS AND/OR DRAINFIELD _2.00_ MANHOLE REFERENCE
CESSPOOL—DRYWELL _UPPER LOWER
—SPECIAL CONDITIONS ONLY 2.00 ( TYPE OF CONNECTION LENGTH FROM
i Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT ; I 00 -
AUTHORIZATION I TOTAL FEE
COAED NTRACTOR TO CONNECT THE ABOVE D SCRIBEDHEREI EXIISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS ______DAY OF-_....... ------------19-------. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT---.___.:_:,.:.:...... BUILDING OR WORK
-------.------....• SEPTIC TANK,SEEP.PIT(S)
ADDRESS. - =_,
- - ................... AND/OR DRAINFIELD
I HER€BY ACKNOWLEDGE THAT I 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
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Fl
SEEP.PIT(S)[:] CESSPOOLS
SIGNATURE t , Lllm
OF PERMITTE _&...-.. f
76A642D 663 12/52 < I