HomeMy Public PortalAbout10539 DANBURY ST_Sewer_7/31/1964_sewer connection i,
A642D 9-83
6APPLICATION FOR PER IT
CE808
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILOING
JOHN A. LAMBIE. County Engineer AODRE Ss
WILLIAM A. JENSEN, Sup'1 of Building
LOCALITY
FOR APPLICANT TO FILL IN NEAREST _ Z'
Cg055 ST,
LEGAL
DESCRIPTION LOT NO. OWNER �'�✓�
//�� MAIL 'I
BLOCK TRACT _ � . j/ -7Ap DR
NO. OFYYYYYY BLDGS. /
SI2E OF LOT NOW ON LOT 7 CITY T.L. INC.
USE OF /J _ DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS r Q ^
A BK PG
, CONTRACTOR / J `� � L�AOB 7
ADDRESS /"j.6 I;6 ((/(✓��_ yCONNECTION DATA
CITY ..�E/ V TEL04; STATION / DEPTH /
} y ��. ❑ STATE MANHOLE REFERENCE PPE
REGISTRATION NO. 4 {._' ❑ COUNTY �S
N DESCRIPTION OF WORK FEE TYPE OF CONNECTIO P.L. LENGTH FROM ��� }
HOUSE SEWER CONNECTING TO Y. CUgR M.L.TO P.L.
PUBLIC SEWER @ S5.00 d
P.C.NO,
SEPTIC TANK,SEEPAGE PIT OR CO.I.E. NO. JOB NO. O
PITS ANO/OR GRAINFIELD @ S10.00 U
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Im
PRIVATE DISPOSAL SYSTEM 53.00 ^
CONNECT ADDITIONAL BLDG.Oft AFFIDAVIT w.11v[p kR"U[ T RECORD, INSTR, NO. DATE rV
WORKTO HOUSE S EW ER @ $3.00 (�
OVERFLOW SEEPAGE PIT.DRAINFI E LD a
EXTN_CESSPOOL.ORYWELL.MANH O LE@ 55,00
ALTER.REPAIR OR ABANDON HOUSE HWY, OR ST.WIDENING h
SEWER OR DISPOSAL SYSTEM @ S.O. STATE ENCROACHMENT z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER'S PERMIT 4 z 00 CHARGES
AUTHORIZATION I TOTAL FEE 1 7 CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN IJA'MED CON- REIMBURSEMENT FEE
TRACTOfl TO CONNECT THE ABOVE DESCRIBED EXIs FG pWELL
ING
TO THE PUBLIC SEWER, APPROVALS GATE INSPECTORS SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIELD
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROWLY REGIS REO ANO/OR ALTER.REPAIR,SEWER OR
LICENSED AS REO V_ BY LOS Al COUNTY NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR AT AM THE LEG OWNE OF, ANO INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABO E DESCRIBED RES�IDEN IAL ROPERTY. ABANDON HOUSE SEWER
SIGNATURE �i� BACKFILL SEPTIC TANKS ❑
OF PERMITT PITIS) ❑ CESSPOOLS ❑
VALIDATION/ ROBERT A. WOOD
CK. M.o. /mac ns// SUPERVISING MECHANICAL ENGINEER
LQ 2 0 7 8w- JUL 31 1 0 D 7.00- V