HomeMy Public PortalAbout10534 DAINES DR_Sewer__ AU42 11-g9 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 0 C
® - CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY 1- -
FOR APPL CANT TO CROSS CROSS ST
LEGAL ` OWNER ������� 3,•, �
DESCRIPTION LOT NO
MAIL
BLOCK TRACT 7 d ADDRESS
NO OF B DGS CITY TEL NO
SIZE OF LOT NOW ON LOT _
USE OF BUILDM=-GS NO GROUP MAP
BUILDI -GS
BK PG
CONTRACTOR j__ A l 14
ADORES S - CONNECTION DATA ¢
STATION DEPTH
CITY TEL. NO MANHOLE REFERENCE _ _ UPPER
/n -7 c
C3 STATE LOWER
REGISTRATION NO C•!t� ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM -
PUBLIC SEWER @ $3 50 Y CURB P L M L TO P L
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 NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ' @ $1 00 TRUNK PERMIT NO PdAD PERMIT NO r.F�
CONNECT.ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 / PERMIT NO -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @' $1 00 WASTE APPROVAL
CHARGES
' I
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE t� REIMBURSEMENT'FEE r
I 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 o
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL G
OWNER OR BUILDING OR WORK ,`J�✓ ,
OWNERS AGENT SEPTIC TANK;SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 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 1 AM PROPERLY REGISTERED AN OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGEL OUNTY AND STA E OF ABANDON HOUSE SEWER
CALIFORNIA O TH T I AM THE LE L OWNER OF THE BOVE
DESCRIBED RE (DENT AL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE9-9
-
JOHN A LAMBIE, C NTY ENGINEER LIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N 0 CASH
�-COS 2 2 OulMAY 1 S 4 . 2.0 0 I�