HomeMy Public PortalAbout10551 DANBURY ST_Sewer_7/30/1964_sewer connection CE808 D 10-63
6A64 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LweG �Q.r� •T _ n
JOHN A. LAMBIE, County Engineer ADDRESS .Jy�JF`1F_/yL
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLICANT FO FML IN `ROSS GT /J
LEGAL C� _ �jg L 13GD�( S
DESCRIPTION LOT NO. r OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF OIL OGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
VBE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS ///� BK PG
CONTRACTOR I�-�' I ��
ADDRESS y r cl n CONNECTION DATA
STATION „( DEPTH
CIiY T.L. i
N STA
REGISTRATION NO. UPPEF
./ -MANHOLE REFERENCE
LD 2._I_ ❑ COUNTY .�
N DESCRIPTION OF WORK FEE TYPE OF CONN ECTI 0 LENGTH F OM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TOP .
PUBLIC SEWER @ $5.00 d
P.G.NO.
SEPTIC AN./OTANK.SEEPAGE PIT OR O O
ITS AND�OR GRAINFIELD @ 510.00 CO.IMP. NO. +� v
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ 53.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT AY 15[Y[ RECORD.INSTR.NO. DATE r
WORKTO HOUSE SEWER 0 $3.00 (J
OVERFLOW SEEPAGE PIT.DRAINFIEL0 W
EXTN..CESSPOOL.DRYWELL.MA RHO LES $5.00 CL
ALTEfl. flEPpIR OR ABANDON HOUSE HWY.OR ST.WIDENING N
BE
OR OISP OBAL SYSTEM 53.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT s z oO CHARGES
AVfHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC BEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY O 19_ ''[[
OWNER OR NEW HOUSE SEWER 7"!Q A
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SUEP.PIT(S)
AND/OR DRAINFIELIELD
AND STATE THAT THE ABOVE IB CORRECT AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑
HEREBY CERTIFY AT I AM PROPERLY HEGISTE D ANp/OR ALTER.REPAIR.SEWER OR
LICENSED AS REO E BY LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR AT AM THE LEGAL NER OF.. NO INTEND
TO DISCONNECT PLUG AND
RESIDE IN. TH ABWE DESCRIBE D ENTI ROPERTY.
4BANDON HOUSE SEWER
SIGNATURE ❑
OF PERM _ BACN FI LL SEPTIC TANKS
EEPTTT,,,.��*PIT�(�^S)�❑ CESSPOOLS ❑
VALIDATION ROBERT A WOOD
cK. M.o, cpsH SUPERVISING MECHANICAL ENGINEER
UCo2 0 0 8z J.30 1 o D 7.00-
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