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HomeMy Public PortalAbout5531 RYLAND AVE_Sewer__ 78A9426 APPLICATION FOR PERMIT CB©69 11-57 COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOAN A. LAMME, Counter Engineer ADDRESS CASSATT D. GRIFFIN, Supt of Building — LOCALITY .y FOR APPLICANT TO FILL IN CROSS ST. ' F..G,,TRAT,ON L - PTION LOT NO. r ' �.{` _OWNER 'TRACT ! ADDRESS :, .� 'yam r .•✓`, '��' " MAIL a. NO.OF BLDGS. T- OFLOT i <'! NOW ON LOT CITY-4— S r i TEL.NOS y$USE GS DISTRICT NO, GROUP MAP- : BK PG CTOR r p .t-.1� ?' ,✓y .._. S < t T ' #� CONNECTION DATA � yL.N0.' r ' f STATION DEFTN STATE- MANHOLE REFERENCE UPPER ATION NO. `�- ,/ 'v:� COUNTY LOWER ND. DESCRIPTION OF WORK FEE : HOUSE SEWER CONNECTING TO PUBLIC SEWER C'a...$3,W-�� �}^ "—F,{`__ --w-`-,.`-••---+-----'. SEPTIC TANK,SEEPAGE PIT OR TYPE OF CdNNECTION LENGTH FROM PITS AND/OR DRAINFIELD C?I $8.00 Y. CURB P.L. M.L.TO P.L, OVERFLOW SEEPAGE PIT,DRAINF'I'ELD EXTN.,CESSPOOL,DRYW_E,L,MANHOLE t1 $2.00 HOUSE SEWER CONNECTING TO Ph". NO.f — PRIVATE DISPOSAL SYSTEMng $1,00 CO.IMP. NO. ,,J6B No. CONNECT ADDITIONAL BLDG.OR f ORK TO HOUSE SEWER @ $1.00 J TRUNK PERMIT NO. -' `ti ROAD PERMIT N0. t WALTER, REPAIR OR ABANDON HOUSE - SEWER OR DISPOSAL SYSTEM @ $1,00 STATE,ENCROACHMENT —�" PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES, OWNER'S PERMIT $ ' >'OQ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE Iy ' REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS _.DAY OF— _19_ rfEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL - OWNERS AGENT _BUILDING OR WORK All DRESS SEPTIC TANK,SEEP,PIT(S) ADDRESS - _ — AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION D - I —� -_--- ANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL E] DRY_WEiL 0 _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. $EWER£ EPAIR,DISPOSA EWER OR I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND EM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEILOUSE DESCRIBED RESIDcP1'.iA4 PROPERT Y.. BACKFILL SEFTiC TANKS �-'--' f,,�''j t SEEP. PITS} I�! CESSPOOLS (� SIGNATURE Ca '' �. - OF-PERMITTE I r VAIIDATION-- ROBERT A. WOOD cr.. M.0. cAsx SUPERVISING MECHANICAL ENGINEER