HomeMy Public PortalAbout5553 RYLAND AVE_Sewer__ 76A
C420
'..5 APPLICATION FOR PERMIT ],
$1k •K53�:
DxwisjoN . ? BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Depunment of CoLn•,y Engineer
County of Los Angeles BUILDING
,XM, : FOX, COUNTY ENGINEER -
DRESS
A"34.-I —GRIFFIN,SUPT OF BuILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST -------
CROSS ST,
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK! TRACT MAIL
DDR_ESS
NO. OF BLDGS. TEL. N0.
SIZE OF L07,—___-
NOW OP7,L0T CITY -
USE OF r_.— --_�..------=-- -- SK p.
BUILDINGS DISTRICT NO. GROUP MA
PG
CONTRACTOR
CONNECTION DATA
ADDRESS
CITY TEL. NO, .,� _.. STATION DEPTH
—~ C3 STATE MANHOLE REFERENCE
REGISTRATION NO. LTL, COUNTY __. UPPER LOWER _
_ --• TYPE OF CONNECTION LENGTH FROM
DESCRfPTION OF WORK — FEE v, cuR6 P.L. M.L.TO P.L.
�j HOUSE SEWER CONNECTING TO r� g-3.50
PUBLIC SEWER
I—HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL IONA1.OSAL SYSTEM 1.00_ _
CONPdEC7 AUDVTBLDG. OR I^ CO. IMP. N0. JOB. NO.
i WORK TO HOUSE SEWER 1.00 ' 'A ------- ---• —
—j ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO.
i SEWER OR DISPOSAL_SYSTEM 1.00 1
-
UPSCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR UISPOS_AL SYSTEM 1.00 I PERMIT NO.
— PE1 TAN DA OR UR EPAGE PIT OR ` `--
_-_ --- — AINFIELD 2.00 1NDlJSTR1AL
_.PI .`— ---I--.--- WASTE APPROVAL
CESSPOOL-DRYWELL i
SPECIA.L CONDITIONS ONLY 2.00J _I _ CHARGES
- -- CONNECTION CHARGE FEE
OW R'S PERMIT ) i 00 -- — -----.—
AUTHORIZATION TOTAL FEE -� i RE;MBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- AFPROI/ALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - --- ---
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS —DAY
CONNECT ADDITIONAL
OWNER -OR BUILDING OR WORK —
OWNERS AGENT. _— ---. --
SEPTIC TANK,SEEP, PITS)
ADDRE55...� -- - _---- — AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL U DRYWELL C3
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ---WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SELVAGE DISPOSAL SYSTEM___ _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL FROPER[Y. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S)_�CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
'Co 5 2 8 E`.^ MI 4 G:: to
BY BY,
DEPUTY DEPUTY
BY BY
DEPUTY