HomeMy Public PortalAbout10124 DAINES DR_Sewer__ E-6D89 if•SS
S& APPLICATION FOR PERMIT
8&E-8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING J
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS , ::1
CAS
SATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER`DESCRIPTION LOT NO. ,;,)BLOCK1 TRACT ! ADDRESSMAI
NO. OF BLDGS. CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF - DISTRICT NO GROUP MAP
BUILDINGS
BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS '� Z � (tiI r
CITY �N`�Q TEL. NO. ` Q sr STATION DEPTH
MANHOLE REFERENCE UPPER
9:1—STATE
COUNTY REGISTRATION NO. l 7 ❑ COUNTY -
NO DESCRIPTION OF WORK FEE . TYPE OF CONNECTIO l LENGTH FROM
HOUSE SEWER CONNECTING TO �n Y. CURB �l M L TO P.L. (r
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. JOB NO
EXTN.,CESSPOOL,DRYWELL,MAN HOLE Q $2 00
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $,1 00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE -
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORSSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DY OF 19 �
CONNECT ADDITIONAL
OWNER. OR �I BUILDING OR WORK
OWNERS AGENT .Gf+ SEPTIC TANK,SEEP,PITS)
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 LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 A THE LEGAL OWNER, OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS C3
OF PERMITT
JOHN-A.,LAMBIE, CoU Y ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CASH
2965 OCT 4 4 .4.50