HomeMy Public PortalAbout10538 DANBURY ST_Sewer_7/31/1964_sewer connection C ESO 640 10-63 APPLICATION FOR PERM
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING -��
JOHN A. LAMBIE. County Engineer ADOHEss
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NE4REST
FOR APPLICANT TO FILL IN :T. --
EGgL 3
DESCRIPTION LOT NO. OWNER I
/j MAIL
BLOCK TRACT �(/ ADDRESS
NO. OF SLOGS,
SIZE OF LOT NOW ON LOT CITY TEL. NO.
VB,::
E OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS
/ K PG
CONTR Ofl
ADDfl CONNECTION DATA
CIT T STATION 3—�- DEPTH l�
STATE2 O � !,VVVVVV/
REGISTRATION NO. COUNTY MANHOLE REFERENCE 1AWiF
NO. GESCR I PTION OF WORK FEE TYPE OF CONNECTION LEN GT FROM
PUSLI CBEWEq CONNECTING TO ® 35.00 Y. CURB P,L, M.L.TO .L. Q Y
SEPTIC TANK.SEEPAGE PIT OR CO. NO, JOB NO. 7(_0 O
PITS AND/OR DRAINFIELO @ $10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM 33,00
CONNECT ADDITIONAL BLDG.OR gFFIDAVIT uv s[x[x D. INSTR.NO.RECORDATE O
WORK TO HOUSE SEWER ® $3,00 F
OVERFLOW SEEPAGE PIT.GRAINFIELD [• V
EXTN_CESSPOOL.DRYWELL.MAN MO LEO $5.00 W
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING U71
SEWER OR DISPOSAL SYSTEM ® 53.00 STATE ENCROACHMENT Z
PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s z o0
CONNECTION CHARGE FEE
AUTHORIZATIONTOTAL FEE 716-
�"d
"IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE .
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. G� ,. APPROVALS DATE INSPECTOR'S IGNATURE
SIGNED THIS 19_
OWNER NEW HOUSE
A
OWNERS AGENT
CONNECT ADDITIONAL
BVILDING OR WORK
ADDRESS
SEPTIC TANK,SEE P,PITISI
I HEREBY THAT
TH LE AGE THAT HAVE READ THIS APPLICATION pND/OR DRgINFIELD
AN0 STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE: AND TE LAWS REGULATING
PLUMBING AND :EWERS. CESSPOOL ❑ ORYWELL ❑
1 HEREBY CERTIFY THAT AMj.LX REGIST REO AND/OR ALTER,RE ISPOS EWER OR
LICEN:EO AS 0 REO RY LO: OVTYAND :TATE OF SEWAGE DISPOSAL:YSTEM
CALI FORM R TH T I AMTHE EOAND INTENDISCONNECT PLUGANO
RE:IDE I THE A VE DESCRI IA PROPERTY. ABANDON HOUSE SE WER
IS GNAT E ❑
OF P IT BACKFILL SEPTIC TANK:
SEEP, PIT IS) ❑ CESSPOOLS ❑ ,.
VALIDATION ROBERT WOOD
CK. M.0. (figs/J SUPERVISING MECHANICAL ENGINEER
LAC0 2 0 7 6w- Sua 31. 1 to o 7.00-