HomeMy Public PortalAbout10930 DAINES DR_Sewer__ &E8B
- o APPLICATION FOR PERMIT
88DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
_.. -.:._
FOR APPLICANT TO FILL IN CROSS ST. Al
LEGA
DESCRIPTION LOT N0. y�rJ T O r pr OWNER
i
MAIL
BLOCK J3 TRACT / D S 9 g ADDRESS V
NO. OF BLDGS. CITY t L. NO. 0� `
SIZE OF LOT NOW N LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
BB+++K PG
CONTRALTO ON
ADDRESS CONNECTION DATA
_ STATION DEPTH
CITY TEL. O.
MANHOLE REFERENCE �J / /
qq INSTATE tX A 6 OWER
REGISTRATION NO. .,,L / ❑ COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO ? I � y_ t� M.L. TO P.L'.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ S 3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. 1 +� P.lOB C-,N00
J3 N0N0.
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 @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE'
OWNER'S PERMIT S 1 00 REIMBURSEMENT FEE
AUTHORIZATION
I HAVE AT THIS TE A CONTRACT WITH T E HEREIN NAMED CON. APPROVALS- DATE INSPECTOR'SSIGNATURE
TRACTOR TO CO CT THE ED EXISTING DWELLING
TO THE PUBLIC E ER. EW
� NEW HOUSE SER
SIGNED THIS DAY OF 191t'4 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT _ tEpTIC TANK,SEEP.PIT(S)
A SSND/OR DRAINFIELD
I HE Y ACKN PLEDGE THAT I HAVE READ THIS APPLIC TION CESSPOOL❑ DRYWELL❑
ND STATE THAT' HE ABOVE IS CORRECT AND AGREE TO COMPLY
1 H ALL COUNT ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLO ING AND S WERS. . SEWAGE DISPOSAL SYSTEM
I HE Y CERT FY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED RE UIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA THAT I M1I THE LEGAL WNER OF THE ABOVE
DESCRIBED RESIDENTIA- OPERTY. BACKFILL SEPTIC TANKS[I /
SIGNATURE SEEP. PITISI ❑ CESSPOOLS
OF PERMITTE
JOHN A. LAMBIE. CO TY E G.[NEER ,,Z5ALIDATION 'ROBERT A. WOOD. CHIEF P1-8G. INSPECTOR
M.O. CASH
LCp2 3 5 6;A NOV14 4 4.50