HomeMy Public PortalAbout10924 DAINES DR_Sewer__ 5 - APPLICATION FOR PERMIT
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66DIVISION OF BUILDIIdG AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer - -
County of Los Angeles - BUILDING % /+
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 4
m CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO TLL N CROSS sr.
LEGAL (�[ OWNER_
DESCRIPTION LOT N , ^ OG TJ
BLOCK TRACT J 9� ADDRESS
/ N0, OF BLT CITY G TEL. N0.82 C"k0l,
SIZE OF LOT N OM LOT
USE OF DISTRICT N0. GROUP MAP
BUILDINGS
F PG e)
CONTRALTO
ADDRESS CONNECTION DATA f �
r IfY
STATIONQ DEPTH
14-4
CITY S f/TEL. NO. �rf�9Lfd A�
MANHOLE REFERENCE /
[J'—STATE / E OWER
REGISTRATION NO. �S �G / / ❑ COUNTY
NO. DON of WORK FFF-----III FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM r/
PUBLIC SEWER @ $3.50 a M.L. TO P.L. .�
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ 'S 3.00
OVERFLOW SEEPAGE PIT,GRAINFIELD CO. IMP, NO. I �� J IOC NO,
O.
EXTN.,CESSPOOL,ORYWELL,MANHOLE 52.00
PRIVATE DHOUSE IISPOSAL SYSTEMER G TO @ $1.00 TRUNK PERMIT,NO. ROAD PERMIT NO./0
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ 51.00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE-
OWNER'S PERMIT S 1 OD
T^
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
.S V
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAME) CDN- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER _
SIGNED THIS DAY OF CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK _
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[_1ORYWELL❑
ANO.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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
r LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF I, ABANDON HOUSE SEWER
V //
CALIFORNIA OR THAT I A THE LEGAL ER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS Dr
OF PERMITTEE /
JOHN A, LAMBIE. CG TY EN (NEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CASH
LACO2354-' NOV 14 4 . 4.50