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HomeMy Public PortalAbout10118 DAINES DR_Sewer__ 781 E,66 APPLICATION FOR PERMIT DNISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of-Los Angeles rADDRESS LDING ' JOHN A LAMBIE, COUNTY ENGINEER �./CASSATT D GRIFFIN, SUP T OF BUILDING - ,� / nALITY �:J v FOR APPLICANT TO FILL IN CROSS ST LEGAL OWNER - DESCRIPTION LOT NO 14 �2 MAIL o BLOCK TRACT ADDRESS NO. O BLDGS CITY TEL SIZE OF LOT NOW ON LOT USE OF DISTRICT NO GROUP MAP BUILDINGS NO _ BK PG ,CONTRACTOR 0 1: © 3 ADDRESS Gj �,�, /ft VAa..rJ CONNECTION DATA � jj CITY A /n 6 �- N TEL. NO STATION DEPTH - ��E MANHOLE REFER ENCE,�� / (� PP (GESTATE \� REGISTRATION ^N0. /� ❑ COUNTY No DESCRIPTION OF WORK FEE R"D It HOUSE SEWER CONNECTING TO TYPE OF ONNECT?*P NGTH FROM Y. CUR PL L TOPL PUBLIC SEWER .@ $3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N 6. EXTN ,CESSPOOL,DRYWELL,M AN HOLE @ $2 00 CO IMP. NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @- $1 00 TR " PIn. _ CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT L 2 WORK TO HOUSE SEWER @ $1 00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL 3 SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERT $ 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE Sa I 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 SEWER. NEW HOUSE SEWER I SIGNED THIS DAY OF 19� CONNECT ADDITIONAL OWNER OR ' BUILDING OR WORK OWNERS AGENT SEPTIC TANK;SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE'THAT THE ABOVE,IS CORRECT AND AGREE TO COMPLY 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 S ANGELES COUNTY'AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I A THE LEGAL ER OF THE ABOVE _ DESCRIBED RESIDENTIAL P PERTY BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS[I - OF PERMITT JOHN A. LAMBIE, C?,fJ&TY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CASH }^ 1 o r ���.�r 13 4 4.5 U L) _ LJ,mooo -