HomeMy Public PortalAbout10817 DAINES DR_Sewer__ EA .8.89 11-55 D
S APPLICATION FOR PERMIT q�
S 8 E �
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer - - - •-^ - - -
County of Los Angeles BUILDING � Drl� 7 � � 7i-'t/_ i
JOHN A. LAMBIE, COUNTY ENGINEER AO.RESS o y �( d'
® CASSATT D. GRIFFIN, SUPTOFBUILDIN. LOCALITY I✓V�
FOR APPLICANT TO FILL IN cRoss ST. i
('� NEAREST
DESCRLEGIPTION LOT NO. \/_ G J I TAD
ER 1f
-Vy L
BLOCK TRACT Q� 1 � F RE55
'r/No"OF L / CITY TEL. NO.�(J t�Z S
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
t �' B= PG
CONTRACTOR s O
CONNECTION DATA
ADDRESS
n f ,• i STATION O S/ � DEPTH `
CITY �� TEL. N0. ,_
� MANHOLE REFERENCE A/� ' 3 A/ UPPER
[.
tlY�IATE '7 V
REGISTRATI 0 I6�7 -2/ El COUNTY
No. DESCRIPTION OF WO K'��—FEE
TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Yf CURB ,Jf;s M.L.TO P.L. S�
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD [@ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $ 2.00 CO. IMP. N0. / JOB ND.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $L00 - TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER rz $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM «. S 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 OD
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE "
I HAVE AT THIS DATE A CONTRACT WIIN TH THE HERENAMED CON- APPROVALS DATE, INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER, o NEW HOUSE SEWER �7 ✓'
SIGNED THIS DAY OFCONNECT ADDITIONAL
OWNER OR _ _ _ BUILDING OR WORK
OWNERS AGENT - ""d- } SEPTIC TANK,SEEP, PHIS)
ADDRESS zefj e AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND -STATE LAWS REGULATING ALTER,REPAIR-SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ECT PLUG AND
O
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
O N HOUSE SEWER
CALIFORNIA 0 THAT I AM T E LEGAL 'NER F THE BO
SIE RIBS RE$/OE NT PROP Y. O/ ' / BACKFILL SEPTIC TANKS❑ ? �yf�
• (J 1 SEEP. PIT(S) ❑ CESSPOOLS[IV ,i qjo
OF�PERMITEEt
JOHN A. LAM IE. COUNTY ENGINEER VALIDATIO ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. Y.O. CASH
f ;�2 2-� FEB15 4 4.50
���Me