HomeMy Public PortalAbout10154 DAINES DR_Sewer__ 5 E-689
8 3 - APPLICATIO'N4 FOR PERMIT ` �1
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• ' DIVISION OF BUILDING AND SAFETY SEWER SEWAGE D I L
Deparbnenf of-County Engineer ;
County of Los Angeles BUILDING /`� (,`,'
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (�J 1J
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
s
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL f J OWNER t
DESCRIPTION LOT NO.
MAIL /
BLOCK TRACT '�. ADDRESS
NO. Of BLDGS. j CITY TEL. NO
SIZE OF LOT NOW ON LOT I ��__��{{,,pp��
USE OF !:1
DIST RI GROUP MAP
BUILDINGS BK PG
CONTRACTOR G P.. Constr. `^v
ADDRESS 225 'J Bryant Rd, D _ CONNECTION DATA ,
CITY El Monte TEL. NO.GZ . 8 -9405 STATION - DEPTH
MANHOLE REFERENCEUPPER
C�ry STATE
152871
1
REGISTRATION NO. ' 5 2 8 `1 ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CON ECTION LENGTH FROM -7
M L.TO P.L. 04,__4�
PUBLIC SEWER @ $3 50 "
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD - P. C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP. NO.-* JOB N0.
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 PERMIT $ 1 Oo
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS AGENTn ( -I — SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD '
1 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
IHEREBY 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 I OM THE LEGAL OW��p OF THE ABOVE _
DESCRIBED RESIDENTIAL OPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) [ICESSPOOLS❑
OF PERMITT E -
JOHN A LIAMBIE. CNTY EN [NEER �1/ALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR