HomeMy Public PortalAbout10940 DAINES DR_Sewer__ 7EA6420•:-:._. APPLICATION FOR PERMIT
S&'E-663 11,55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Eagtneex ' - -- -
County of Los Angeles BuumNG Q _'
ADORES$ '
' JOHN A. LAMBIE, COUNTY ENGINEER 1
GJ CASSATT D. GR I FFIN, SLIPTO�BU I LDING LOCALITY. V
FOR APP I. AT NEREs . qART
iA / �.
LEGAL ' 1 /J OWNER ad'd /-
_ DESCRIPTION �1}Lp p. / �/L�.✓/t �y�/�
iL v Q %'-i ADDRESS MAI /D 7 `f r'^�C[J�s�+�d "--C/
�� � / NO.OF BLO 5. CITY 9 TEL. N0.
I. SIZE OF LOT �- L NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS BK PG.
CONTRACTOR
ADDRESS J CONNECTION DATA
TE STA 1 ' DEPTH
CITY
MANHOLE REFERENCE UPPER
/� ❑ STATE p.. LOWER
REGISTRATION N0. J ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM ✓
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50 y, CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. [.
EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $2.00 CO. IMP. N0. l0 0.
HOUSE SEWER CONNECTING TO
_PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PE MIT NO.
CONNECT ADDITIONAL BLDG.OR 'v' STATE ENCROACHMENT
f WORK TO HOUSE SEWER @ $1.00 y PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL $+(
SEWER OR DISPOSAL SYSTEM @ b 1.00 WASTE APPROVAL
/ ;RARGES
ir
CONNECTION CHARGE FEE' �/ Xe,- /Q
OWNER'S PERMIT s 1 0o
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE ✓
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- . APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING X
TO THE PUBLIC SEWE NEW HOUSE SEWER
TRI F 19>T A CONNECT ADDITIONAL
OWNER t K
OWNER OR / BUILDING OR WORK -
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS ��+*-per AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AND
PLUG A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF pISCONNECT ABANDON HOUSE PLUGD
ER
CALIFORNIA OR THAT I AM THE LEGAL OWN OF THE ABOVE
DESCRIBED RESIDENTIAL PR TT. ^ '. BACKFILL SEPTIC TANKS E)
SIGNATURE
r SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY E GINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECT
CK. NO O CASH
x.04 5 3 JAN21 4 5.50