HomeMy Public PortalAbout10408 DAINES DR_Sewer__ - D
IS 116
APPLICATION FOR PERMIT 1
E 8DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County Of L08 Angeles BUILDING
JOHN A LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY ��_�� �� ,�•
FOR AP I NT L CROSS ST
LEGAL OWNER
DESCRIPTION LOT NO ` 2,97
BLOCK TR MAIL
ADDRESS
NO OF BLDG
SIZE OF LOT NOW ON LOT TY TEL NO �!
USEORICT NO GROUP MAP
NG
DISTBK PG
CONTRACTOR ,.J
ADDRESS NEC
CONTION DATA
STATION DEPTH
CITY TEL NO
MANHOLE REFS ENCE _ UPPER
NO
STATE LOWER
REGISTRATION ❑ COUNTY
No DESCRIP ION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF NNECTION LENGT FROM
PUBLIC SEWER @ $3 50 Y• C RB P L M O P L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELDP C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 -CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT N N ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCRO HMENT
WORK TO HOUSE SEWER @ $100 PERMIT NO
ALTER,REPAIR HOUSE INDUSTRI
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE A PROVAL
CHARGE
CONNECTION CHARGE FEE
OWNER'S PERBUT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY 19
CONNECT ADDITIONAL �
OWNER OR ��, ,��J n
BUILDING OR WORK
OWNERS AGENT��42tg 6JC�.±b SEPTIC TANK,$EEP,PIT(S)
ADDRESS « '� 7[-� n^ /L�J,1LAND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL 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 LO ANGELES C NTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I A HE LEGALXW ER OF THE ABOVE
DESCRIBED RESIDENTIA P RTY BACKFILL SEPTIC TANKS C3SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE. Cour,� Y ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK M O CASH
232 '2 -mAY27 - - 4-V , 300