HomeMy Public PortalAbout10420 DAINES DR_Sewer__ CES08 8.5( APPL1CSA ION FOR PE MIT
ceeoe a.se COUNTY OF LOS ANGELES
SEWER-SEWAGE ISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, Count Engineer ADDRESS I -
CASSAST D. GRIFFIN, Supt of Building LOCALITY T`
IN
EAREST
FOR APPLICANT-TO FILL IN CR"S ST.
LEGAL
DESCRIPTION LOT NO. .5 OWNER �!�Ilit✓
BLOCK TRACT MAIL
�` ADDRESS L
0.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT N0. GROU MAP P E S BY
K PG �,ry
CONTRACTOR ^� O I r 7
ADDRESS C014NECTION DATA
CITY TEL.N - STATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO / COUNTY " LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO h fl
PUBLIC SEWER @ $9,00 CJ TYPE OF CONNECTIO LENGTH FROM
_ SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L.I M.L.TO P.L. \1
PITS AND/OR DRAINFIELD @ $3,00
OVERFLOW SEEPAGE PIT, DRAINFIELD I '
EXTN CESSPOOL DRYWELL @ $2,00
HOUSE SEWER CONNECTING TO •P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1 00 '
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE -0-0 REIMBURSEMENT FEE
TRACTOR TO HAVE AT CIONNECT TE A HE ABOVE DESCRIBED EXCONTRACT WITH THE ISTING DWELLNAMED ONG APPROVALS DATE IN ECTOR'S SIGNATURE
TO THE PUBLIC SEWER. .j
SIGNED THIS DAY OF 19- NEW HOUSE SEWER M LA
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP PIT(S)
AND/OR-DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORD_INA S A STATE LAWS RE ULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, QL _1Z SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TH 1 AM PROPE Y REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIR BY LOS ANGELE COUNTY AND STATE OF ABANDON
HOUSE SEWER
CALIFORNIA OR TH 1 AM THE LE L OWNE OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDE L PROPERTY. _
SIGNATURE SEEP.PIT(S)
ITS ❑ CESSPOOLS ❑
OF PERMITTE
®R VALIDATIOK� ROBERT A. WOOD
CK. _ M.C cAsB SUPERVISINGHA MECANICAL. ENGINEER I