HomeMy Public PortalAbout10823 DAINES DR_Sewer__ 76A9.6 APPLICATION FOR PERMIT_
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
..,Department of County Engine: " - ' /T
County of Los Angeles BUILDING -
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING 'LOCALITY
FO P C NT FILL moss ST. G
LEGAL ♦ _
DESCRIPTION LOT N '� OWNERMAI I
BLOCK t . TRACT ' ��� �3 ., �J ADDRESS
NO. OF BLDGS. CITY TEL. NO.
512E OF LOT NOW ON LOT
USE OF
BUILDINGS BK PG
- DISTRICT NO. GROUP MAP
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL. NO, STATION DEPTH -(�
d— MANHOLE,REFERENCE
qj,yam STATE - LOWER
REGISTRATION N0: / �D �\ 9♦+ COUNTY
No. DESCRIPTION O WORK' FEE
CTION LENGTH FROM /
HOUSE SEWER CONNECTING TO Y- TYPE OF RB P.L. M.L. TO P.L. �
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, GRAINFIELD P. C. NO.
EXTN.ICESSPOOL,DRYWELL,MANHOLE @ $R.00 CO. IMP. N0. - lOB NO.
ER
PRIVATE DHOUSE ISPOSAL SYSTEMG TO @ $1.00
TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE ._
OWNER'S PERMIT g 1 DD
AUTHORIZATION ( TOTAL FEE 1 t REIMBURSEMENT FEE '
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS' DATE INSPECTORS SIGNATURE _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 777
TO THE PUBLIC SEWER, - NEW HOUSE SEWER
SIGNED THIS DAY OF 79 CONNECT ADDITIONAL
OWNER AR BUILDING OR WORK
OWNE { SEPTIC TANK,SEEP,PIT(S)
ADDRESS �L l I A �I AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ ❑RYWELL❑
'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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - ABANDON HO PLUGA D '
CALIFORNIA OR THAT I' AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERT _ BACKFILL SEPTIC TANKS❑ IL
SIGNATURE SEEP.PIT(5) LlCESSPOOLS
OF PERMITTEE
JOHN A.LAMBIE. NTY ENGINEER VALIDATION ROBERT.A. WOOD. CHIEF PLBG. INSPECTOR
.aCX.
11.0. CASH
lL09 8 0 6A. AUG'31 . -4 ..4.50 n