HomeMy Public PortalAbout10544 DANBURY ST_Sewer_7/31/1964_sewer connection CE80810-63 APPLICA(((/TIONJFOR PERMIT
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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 ADOREss
WILLIAM A. JENSEN, Sup't of Building I
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `"°E$ STRig
,
ESCLEGAL
RIPTION LOT NO.
y MAIL
BLOCK TRACT J � , ADDRESS 6001
S
NO. OF BLD.
SIZE OF LOT NOW ON LOT CITY 7.r, TEL. NO.
USE OF DISTRICT NO. GROUP I MAP PROCESSED BY
BUIL OINGS 17_
BK PG L/
CONTRACTOR 6, _� ':s7_O? ! L.-c, [_4 C?,- GOi+�C+-cJ
ADDRESS 3 'G/,/cj. -_ 1/ j / -✓� CONNECTION DATA
CITY S SV • TEL. W1O STATION ...I- a 1� ` DEPTH
BOUNTY
I V UPPER
REGISTRATION NO. Z L/ Z COUNTY MANHOLE REFERENCE //'
� C -
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION GLENGT FROM ^�
HOV BE SEW ER CONN ECTINGTO A..,'1 Y. CURB P.L. M.L.TO P.L. Q }
PUBLIC SEWER a $5.00 VV
SEPTIC TANK.SEEPAGE PIT OR P.C.NO. O
PCO.I.P. NO. No:
AND/OR DRAINFIELD @ $10.°0 JOB /
V
MOOSE SEWER PRIVATE DISPOSAL SYSTEM S3.00
TO SS 00 TRUNK PERMIT NO. ROAD PERMIT NO.
N.
CONNECT ADDITIONALBLDG.OR AFFIDAVIT w11Y[4 NE[N[Ni RECORD. INSTR.NO. DATE O
WORK TO HOUSE BE WE R 33.00 F
OVERFLOW SEEPAGE PIT.GNAINF I ELD V
EXTN..CESSPOOL.DRYWELL.MANHOLE $S.00 W
ALTER.REPAIROR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM ® S3.00 STATE ENCROACHMENT z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s z o0
AUTHORIZATION TOTAL FEE 7 Py 0 CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S SI NATURE
SIGNED THIS DAY OF 19_
OWNEROR NEW HOUSE SEWER ] _
OWNERS AGENT CDNN ECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP.PIT(S)
IN
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR
LICENSEO AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN,
THE ABOV DESCRIBED HENTIAL PR PER_LbTY. ABANDON HOUSE SEWER
$I GNATV qE II1SA KFILL SEPTIC TANKS ❑
OF PERMITTEE ,PIT I51 ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
CK. M.0.
CASH SUPERVISING MECHANICAL ENGINEER
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