HomeMy Public PortalAbout10933 DAINES DR_Sewer__ M669 11.55
S&E.-66APPLICATION FOR PERMIT- GGSTII
9& II
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL J'I6
Department of County Engineer - -
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLIC .W�� IIy 117 L CRD55NEAREST ST.
LEGAL Y � / OWNER
S
DESCRIPTIONLOT NO. ^�
MAIL
BLOCK 4 TRACT / {a� L� ADDRESS/I;)SIZE OF LOOTT NOWW ON LOTT -A
SIZE
FNJOBL / CITY TEL. N.jEa 022k
OV/
USE OF .._.
BUILDINGS DISTRICT NO. GROUP MAP
' SK
CONTRACTOR
r // d
CONNECTION DATA
ADDRESS /A�� ( 3 ,
CITY TEL. NMANHOLE REFERENCE : /E.0 OWER
REGISTRATION NO ❑ COUNTY -
No. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF 4iG TION - LENGTH FROM -�
PUBLIC SEWER @ $3.50 d CURB M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. N0. l3 JOB NN
C
EXTN.,CESSPOOL,DRYWELL,MANHOLE $ 2.00
HOUSE SEWER CONNECTING TO {
PRIVATE DISPOSAL SYSTEM @ S 1.00 TAUNK PERMIT N0. ROAD PERMIT NO./DI-5 92 Q
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER r@ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Qa ;1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 00
Sa REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE `
I HAVE AT. THIS DATE A CONTRACT WITH THE HEREIN N MED CON APPROVALS DATE INSPECTOR's SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - 00,
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS Y O 19 CONNECT ADDITIONAL
OWNER OR � 'A BUILDING OR WORK "
OWNERS AGENT (�/ / SEPTIC TANK,SEEP, PIT(S)
ADDRESS / / ANO/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND 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
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEG OWNER OF THE ABOVE _
DESCRIBED RESIDENTIA ftOPERTY. BACKFILL SEPTIC TANKS❑ I
SIGNATURE sEEP.PIT LL S) [1CESSPOOLS UD
OF PERMITTE
JOHN A. LAMBIE. CZUNTYENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
M2 .3 5 8 nroV 14 4 4.5 0 -�