HomeMy Public PortalAbout10564,10600 DAINES DR_Sewer__ 96AB42D APPLICATION FOR PERMIT G
S C E-66S 11-65 II
DIVISION OF BUILDING AND SAFETY ' SEWER—SEWAGE DISPOSAL 11IS
Deportment of County Engineer
County of Los Angeles BHI LDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS e /
® CASSATT D. GRIFFIN. SUPT OF 13OI10ING LOCALITY
FOR APPLICANT JTO FILL IN cRoss sr. r
LEGAL
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT ADDRESS
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NO. OF BLDGS. 9 CITY TEL. NO DL
SIZE OF LOT NOW ON LOT V d
USE OF _ .. ... .
BUILDINGS I^ 42d DISTRICT-, GROUP y/`MAP
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CONTRACTORA� T BA/ /1,
ADDRESS CONNECTION DATA J
CITY lCJ2-ta.eL.tA. TEL. NO. n ��� STATION it �V DEPTH
MANHOLE REE FERENCE [^? ' J LOWER
STATE
REGISTRATION NO.
° Y V d
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONN ECTIO LENGTH FROM'
PUBLIC SEWER @ $3.50 Y. CURB p L M.I.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ $3.00
EXTNF CESSPOOL.ORYWELOVERLOW SEEPAGE PIT, DL,MANHOLE @ $2.00 CO. IMP. NO.RAINFIELD JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $LOD PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $LOU WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT E t 00
AUTHORIZATION TOTAL. FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSP ECTOR'S BIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS D Ig_ CONNECT ADDITIONAL
OWNER OR ` ' BUILDING OR WORK
OWNERS AGENT 0 t '! SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[D 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
( IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNT 0 THE ASTATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL 0 OF BOVE - ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P 0 BACKFILL SEPTIC TANKS°
SIGNATURE _ SEEP.PIT(S) ° CESSPOOLS°
OF PERMITTEE -
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M. 0. CASH
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