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HomeMy Public PortalAbout10536 DAINES DR_Sewer__ 7 a E-669 1t-98 APPLICATION FOR PERMIT 1 8&E-68 'DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Depar ent of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESSI CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITYFOR APPLICANT TO FILL IN ceoss sr LEGAL ♦ .,$� / DESCRIPTION LOT NO ,. , ��•( OWNER s P ' ADDR . AIL BLOCK TRACT ADDRESS - �/ / NO OF BLDGS CITY TEL NO SIZE OF-LOT pZ ]L�f7 NOW ON LOT USE OF BUILDINGS ' DISTRICT U_ GROUP MAP ` CONTRACTOR �� 'a � 15 r BK MAP /PG ADDRESS �i �^ CONNECTION DATA L L ` STATION / '� DEPTH CITY TEL NO W77<24 7 7 MANHOLE REFERENCE STATE � LOWER ❑ REGISTRATION NO , Z 7 9 rp ❑ COUNTY - r�© �2 No DESCRIPTION OF WORK FEE � �z,� • HOUSE SEWER CONNECTING TO -- TYPE TYPE OF CONNECTIO LENGTH FROM PUBLIC SEWER @ $3 50 V Y• CURB P L M L TO 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 IM NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1 — TRUNK PERMIT NO - ROAD PE IT NO CONNECT ADDITIONAL BLDG OR /� STATE 1CROACHMENT WORK TO-HOUSE SEWER @ $1 00 00 PERMIT NO- ALTER,REPAIR OR ABANDON HOUSE s INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL X'CtIARGES CONNECTION CHAR FEE_ _ OWNER'S PEST $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEME FEE' -t I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APP-OVALS DATE INSPECTOR SSIG TURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER NEW HOUSE SEWER . J! SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER ORI�!� BUILDING OR WORK OWNERS AGENT Jt=, Aj SEPTIC TANK,SEEP,PITS) 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 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, THE ABOVE WER DESCRIBED RESIDENTIAL PROPERT // BACKFILL SEPTIC TANKS❑ SIGN/ 'URF �Q '1� U SEEP PIT(S) ❑ CESSPOOLS❑ OF� R,M T`£� G.biii.•/// , JOHN A LAM IE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF-PLBG INSPECTOR ' CK !d O CAS _ - - �1 ;� i AC0 4 9 7 5- FEB 8 4 3