HomeMy Public PortalAbout10036 DAINES DR_Sewer__ 9808-D
0saoe• APPLICATION FOR PERMIT:
e•se COUNTY OF LOS ANGELES
SEWER-SEWAGEDISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDING :71
JOHN A. LAMBIE. County EngineerADDRESSCASSATT D. GRIFFIN,Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL w 0 dDESCRIPTION LOT N0. OWNER BLOCK TRACT MA[L 'ADDRESSN0.OF BLDGS.SIZE OF LOT ;9X NOW ON LOT CITY I TEL.
USE OF
BUILDINGS A/�—' �-1 DISTRIO. GROUP, MAPOCESSED Y '
1 BK PG (
CONTRACTOR
n
ADDRESS '�' CONNECTION DATA
CITY A TEL.NO. �y p STATION DEPTH gf
8 STATE MANHOLE REFERENCED' LOWER
REGISTRATION N0. - COUNTY
NO. DESCRIPTIO OFWORK- FEE
HOUSE SEWER CONNECTING TO i9•i1
PUBLIC SEWER Q $8.00 V TYPE OF;CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR' Y. CURB` P.L.
M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $9.00 _
OVERFLOW SEEPAGE PIT-, DRAINFIELD - -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM $1.00 JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N
WORK TO HOUSE SEWER $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM $1.00 - PERMIT NO.
INDUSTRIAL -
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC EWER.
SIGNED THIS AY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL -
OWNERS AGENT BUILDING OR WORK,
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I•HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN I PROPERTY. / BACKFILL SEPTIC-TANKS❑
SIGNATURE
SEEP.PIT(S) CESSPOOLS,[]
OF PERMITTE
®r VALIDATIO ROBERT.4.WOO
pa, g,G, CAe SUPERVISING MECHANICAL EN INNER
AP065. 83v; "'AY1-88 0 A 240.00 � �: -
LAC0�6 5.8 an` MYg 1 G A 5.00 M