HomeMy Public PortalAbout10550 DANBURY ST_Sewer_7/31/1964_sewer connection A
76A542O 0-63 APPLICATI N FOR PERM
C EODe
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR ET N... FILL IN OWNER _
LEGAL I
DESCRIPTION LOT NO. ) OWNER /J
MAIL
O / AODRE
BLOCK TRACT 1T
NO. OF GLOSS. /
SIZE OF LOT NOW ON LOT CITY L. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP K MAP PROCESSED BV
RG
CO _ .' D� Bl�ti.L ti. cG'ic,
ADDRESS )/ f A CONNECTION I A
CI T •� STATION �2 71- DEPTH C9
IJ /�
� STATE ,� '}�� PPER
REGISTRATION NO. Q(("/ COUNTY ' MANHOLE REFERENCE /
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR �n }
PPCUBLSIC SEWER CONNECTING TO SS OO < V. CURB P.L. M.L.TO P.L. (�
V D
NO
SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB NO. �-7a O O
PITS AND/OR DMAINFIELO @ E10,00 V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, W
PRIVATE DISPOSAL SYSTEM $3.00 /Y
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wgYO [niEx Exi RECORD.INSTR.NO. DATE VF
WORK TO HOUSE SEWER ® 33.00 U
OVERFLOW SEEPAGE PIT.GRAINFIELD W
EXTN..CESSPOOL,DRYWELL,MAN HOLE @ $5.00O_
ALTER.REPAIR OR ABANDON HOUSE HWT. OR BT.WIDENING V)
SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S z 00 CHARGES
AUTHORIZATION TOTAL FEE 7 CONNECTION CHARGE FEE
'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIB XISTING DWELLING
TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S IGNATU RE
SIGNED THIS F 19_ 4.
OWNER OR / NEW EWER
OWNERS AGENT
CONNECT ECTA.D.DITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,FIT(S)
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AryD/OR GRAINFIELD
AND STATE THATT4E ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY
NTV ORDINANCEE S AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRVWELL ❑
I HEREBY CERTIFY T 1 AM P REGISTERED ANO/OR ALTER.REPAIR,SEWER OR
LICENSED AS REOUIR BY OS ANGLE OUNTY A STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH AM HE LEGAL W ER OF, D INTEND TO
RESIDE IN, THE A VE SCRIBED R IDE TIAL ROPERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATURE ❑
OF PERMITTEE BACKFILL SEPTIC TANKS
SEEP,PIT IB) ❑ CESSPOOLS ❑
VALROBERT WOOD
M.0. cgSH
CK. M.o. SUPERVISING MECHANICAL ENGINEER
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