HomeMy Public PortalAbout10144 DAINES DR_Sewer__ S&E`8 311.55 - APPLICATION. FOR PERMIT _ -
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
t, County Of LOS Angeles BUILDING y „
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY
t
-FOR APPLICANT TO FILL IN CROSS ST
'LEGAL ' OWNER
DESCRIPTION LOT NO - `
BLOCK" - - TRACT MAIL f ,
t2 ADDRESS
NO.OF BLDGS ' CITY TEL. NO
SIZE OF'LOT NOW ON LOT
,
BUILDINGS DISTRICT NO. J GROUP MAP ,
BUILDI
PG
CONTRACTORi - 0
ADDRESS -5 r w - CONNECTION DATA
CITY
STATION L DEPTH
�t'L.�N TEL. NO.���`— Q MANHOLE REFERENCE 00
/ _ I UPPER '
Q—STATE
REGISTRATION NO / Z,. ❑ COUNTY - _
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIOtk/ LENGTH FROM
HOUSE SEWER CONNECTING'TO Y. P L. J M.L.,TO P.L.CURB
PUBLIC SEWER @ $3 50 .�
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 'Q $3 00 ,
OVERFLOW SEEPAGE PIT,DRAINFIELD P C: N0.
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP. NO. JOB NO.
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
OWNER'S LPERMIT V 1 00
AUTHORIZATION. TOTAL FEE REIMBURSEMENT FEE
- T
I H'AVE,AT•THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECR SSIG ATURE
.�
TRACTOR TO ,CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. c NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL '
OWNER OR
ti BUILDING OR WORK
OWNERS -AGENT s1�Lf �'�
SEPTIC TANK,SEEP,PIT(S) _
ADDRESS .AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
F HEREBY CERTIFY THAT 1 AM' PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT LUGSE AND - i
CALIFORNIA OR THAT I M. THE LEGAL OWNER,OF THE ABOVE
DESCRIBED RESIDENTIA ROPER BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) [I CESSPOOLS[ISIGNATURE
OF PERMITT
JOHN A. LAM BIE, NTY_ ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
K. L7
Q., , CASH - -
Ilio 2 9 6 6 U bu, 4 4 4-50 , M