HomeMy Public PortalAbout10828 DAINES DR_Sewer__ J8gB420APP LI CATI O III.. FOR PERMIT
58E863 11;5S
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dep(atnent of County Engineer
County of Los"Angeles ADDREssG Zd
JOHN A.-LAMBIE. COUNTY ENGINEER 3
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY �� � -
FOR APPLICANT TO FILL IN CROSS ST.
LEGALIBJ i
DESCRIPTION LOT NO. �'1 ONA % /�/ OWNER J� ,
BLOCK 'TRACT „ ! MAIL
ADDRESS
NO. OF BLDGS. CITY TEL. N0. _
SIZE OF LOT NOW ON LOT -
USE
OF
BUILDING$ i./ DISTRICT NO. GROUP MAP
UI
BK PG
CONTRACTOR
ADDRESS .( CONNEE;TION DATA r 11�-.--
T(e
_ f® I STATION DEPTH
MANCI �i/f� TEL. NO. STATA HOLE REFERENCE EP UPPE
J - ❑ STATE1S
- REGISTRATION NO. 1 �� O ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
_ TYPE OF CO ECTION LENGTH FROM
HOUSE SEWER CONNECTING TO ., Y. P.L. ' L.
TO P.L.
PUBLIC SEWER @ S 3.50. Gv
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD J CO. IMP. N0. J ,� JOB NY
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $ 2.00
ER
PRIVATE DHOUSE ISPOSAL SYSTEMG TO @ S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO./O/Ll A/{9
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S IOU PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTEAPPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 OO
AUTHORIZATION I TOTAL FEE REIMBURSEMENTFEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN VAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE // NEW HOUSE SEWER I 1!!
SIGNED THIS D OF A� CONNECT ADDITIONAL
OWNER OR �Y //�f�� � ��JJ BUILDING.OR WORK -
OWNERS AGENT `(l V c�"C^� SEPTIC TANK,SEEP,PIT(S)
ADDRESS 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 THATI' AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE L L OWNER OF THE ABOVE p
DESCRIBED RES I DENTIAL,PROPERTY. BACKFILL SEPTIC TANKS❑
{ SIGNATURE SEEP.PIT(5).❑ CESSPOOLS- p { 1Z7X Jf
OF PERMITTEE
JOHN A: LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M. O. CASH - '