HomeMy Public PortalAbout10258 DAINES DR_Sewer__ D
S E-689 I1-96 /APPLICATION FOR PERM-IT
B&E•8 ,
DIVISION OF BUILDING AND SAFETY SEWER-SEWA ,DISPOS
Department of County Engineer 01
County of Los Angeles BUILDING O
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
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CASSATT D GRIFFIN, SUPT OF BUILDING t C - 1
LOCALITY
FOR APPLICANT TO FILL IN CRO SIT . If
LEGAL OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USE OF DISTRICTN0.
BUILDINGS GROUP MAP
- BK PG
CONTRALTO t--
CONNE ON DATA
ADDRESS
STATION DEPTH
CITY TEL. NO. �� MANHOLE REFERENCE
STATE LOWER
REGISTRATION N0. ❑ COUNTY
NO. DESCRIPTION 0 R FEE ,
TYPE OF CONNECTIO LENGTH FROM_
HOUSE SEWER CONNECTING 0 Y. CURB P.L M L.TO P.L.
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR '
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD ` P C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP N0. / y JOB NO. '
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER @ $1 00 PERMIT NO '
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL-
SEWER OR DISPOSAL SYSTEM @ $100 WASTE APPROVAL 1
CHARGES
CONNECTION CHARGE'FEE -
OWNER'S PERMIT $ 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT 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 P _IC SEWER NEW HOUSE SEWER 7-�-dmf
SIGNED T DAY O 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ,
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
LI ENSED AS REOU RED BY LOS ANGELES COUNTY AND STAT OF AB DON HOUSE SEWER
C IFORNIA OR -T AT I A �1E LEGA OWNER THE E
D E(g�'�'SIDE L P RTY pFILL PIT(S) El CESSPOOLS❑
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JOHN A LAMBIE, COUNTY GINEE VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
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