HomeMy Public PortalAbout10545 DANBURY ST_Sewer_7/30/1964_sewer connection CCo' 10-63
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAD.
O�
JOHN A. LAMBIE, County Engineer !/
WILLIAM A. JENSEN, Supt of Building
FOR APPLICANT TO F L INEGALDESCIPTION LOT NO. y�BLOCK TRACT O `J /V/
OF SLOG .
SI2E OF LOT NOW ON LO CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROU MAP PROCESSED BY
— � /', r/ BK PG
CONTRACTOR
AID REy; y CONNECTION DATA
CITY TEL. STATION DEPTH
UPP
STATE
REOIETRATION NO. �� COUNTY MANHOLE REFERENCE —
NO. GESCRI PTION OF WORK FEE TYPE OF CONNECTION LENGTH OM
HOUSE SEWER CONNECTING TO /➢� Y. CURB P.L. M.L.TO .L.
PUBLIC SEWER $5.00 V�V
SEPTIC TANK,SEEPAGE PIT OR
CO.IMP.NO.
ITS AND/OR DRAINFIELD @ SIOOO
P
HOUSE S LWERCON-ECTI NG TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ S3.00 m
CONN ECT ADDITIONAL SLOG,OR AFFIDAVIT uv[R [ns[x[xT RECOR°.INSTR.NO. DATE O
WORK TO HOUSE SEWER $3.00 u
OVERFLOW SEEPAGE PIT.DRAINFIELD W
E%TN.,CESSPOOL,DRYWELL.MA NHO LE a $5.00 d
ALTER.REPAIR OR ABA N°ON HOUSE I HWYrNEW
OR ST.WIDENING yI
SEWER Oft OISPOBAL SYSTEM @ $3.00 ENCROACHMENT z
T NO.
TRIAL
E APPROVAL
CHARGES
OWNERS PERMIT 5 2 00
AUTHORIZATION TOTAL FEE ECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN MED CONBU ftSEM ENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E%ISTI DWELLING
To THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR OUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP.PITtS)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTER D AND/OR ALTER, REPAIR,SEWER OR
LICENSED AS REOUI Y LOS ANGLES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNI4 Ofl T 1 THE LEGAL O R O AN INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE OV DESCRIBED RE51 TIA RO RTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERM SEEP.PITC) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
K. M.o. CASH SUPERVISING MECHANICAL ENGINEER
LXD2 0 0 7—� X30 1 0 D 7.00-