HomeMy Public PortalAbout10140 DAINES DR_Sewer__ ED
sa APPLICATION FOR PERMIT. ,
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8 @ E-669 11•'7
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depax ent of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN. SUP 7 of BUILDING LOCALITY
FOR APPLICANT TO FILL, IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
MAIL /
BLOCK TRACT i-y-•�'1 ADDRESS
NO. OF BLDGS
,SIZE OF LOT - NOW ON LOT CITY TEL.
USE OF C T I
DSTRICNOS I GRA MAPPG
r I
BUILDINGS T T
CONTRACTOR
ADDRESS Z �d CONNECTION DATA
STATIONDEPTH
CITY TEL. NO
MANHOLE REFERENCE,
•� PPER
-ESTATE
REGISTRATION NO 2 / ❑ COUNTY - -
NO DESCRIPTION OF WORK FEE
TYPE OF CON ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO yy�v J
PUBLIC SEWER @ $3 50 L+Ti� / M L TO P L.
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT.DRAINFIELD P C NO F,09
_� '
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $ 2 00 CO. IMP. NO. �IG&-ALB—
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 @ $1 00 PERMIT '
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q_ $1 00 WASTE APPROVAL
ARGES
" CONNECTION CHAR EE
OWNER'S PERMIT s 1 00
AUTHORIZATION TOTAL FEE REIMBUR ENT FEE
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
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR I BUILDING OR WORK
OWNERS.AGENT � "' SEPTIC TANK,SEEP, PIT(S)
ADDRESS - AND/OR DRAINFIELD
1 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 ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I HE LEGAL O ER OF THE ABOVE
DESCRIBED RESIDENTIAL P ERTY BACKFILL SEPTIC TANKS❑
SIGNATURE` SEEP PIT(S) ❑•CESSPOOLS[3 `
OF PERMITTEE ,
a
JOHN A LAMBIE, CO TY ENGINEER ,---y4LIDATION ROBERT A WOOD. CHIEF PLBG. INSPECTOR
CK. M 0. CASH - -
�i � 1 0 mxv 13 4 4.50
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