HomeMy Public PortalAbout10134 DAINES DR_Sewer__ 7
a E.66 APPLICATION FOR PERMIT 1
S .BeDIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS /
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CR"S ST.
LEGAL
DESCRIPTION LOT NO OWNERMAIL
BLOCK - TRACT ADDRESS
NO. OF BLDGS CITY TEL NO,
SIZE'OF LOT NOW ON LOT
USE OF - 'DISTRICT NO. GROUP MAP
BUILDINGS, 6fw -
/BK PG
CONTRACTOR /" LV 3
ADDRESS "Z •Z �. �( CONNECTION DATA
' STATION DEPTH
CITY Jt+t 0 TEL N0. MANHOLE REFERENCE PER
E4--STATE
REGISTRATION NO. / 2 7 ❑ COUNTY t -NO DESCRIPTION OF WORK FEE
• �.YPE OF CONNECTIO LENGTH FROM T�
HOUSE SEWER CONNECTING TO �1'� P L M L TO P.L J
PUBLI C,SEW ER @. $3 50
SEPTIC TANK,SEEPAGE PIT OR I -
PITS AND/OR DRAINFIELD @ $3 00 ,
OVERFLOW SEEPAGE PIT, DRAINFIELD - - P. C. NO. �� O
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP. NO. - -
HOUSE SEWER CONNECTING TO _ -
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK P IT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG O.R. STATE ENCROA H ENT -
WORK TO HOUSE SEWER@ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
r
CHARGE
CONNECTION CHA!��PE
OWNERS . PERMIT $ t 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE S .
APPROVALS DATE IN SPECTOR,S SIGNATURE,
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - i
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING � � �
TO THE PUBLIC SEWER - NEW HOUSE SEWER '`L
SIGNED THIS DAY OF 19, CONNECT ADDITIONAL
OWNER OR- �•'/��J/.� Y BUILDING OR WORK' -
OWNERS AGENTyL�,C-(CfA—�' `` n �� SEPTIC TANK,SEEP,PIT(S) '
ADDRESS 'AND/OR DRAINFIELD '
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL{] DRYW ELL❑-- -
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 L S ANGELES COUNTY AND STATE OF ABANDON HO PLUGAUSE D
CALIFORNIA OR .THAT I A HE LEGAL NER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PERTY, : BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) [I CESSPOOLS ElSIGNATURE ,
OF PERMITTEE -
JOHN A LAMBIE. C NTY EAGINEER ALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR
• CK. tl 0
CASH
t may 13 � 4 4.50 �'.