HomeMy Public PortalAbout10940-10942 DAINES DR_Sewer__ °A° APPLICATION FOR PERMIT
BeE,°°DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer - - - -
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County of Los Angeles BUILDING
.JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS v
® - CASSATT D. GRIFFIN. SUPT OF EIOILDING LOCALITY
F AP LI AN LL IN ceOSS ST. ,
LEpp.ggLt yy/� � � OWNER -
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BLOCK TRACT tlq 6 ADDRESS
NO. OF BLDGS.
SIZE OF LOT Y NOW ON LOT CITY _{/�
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
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ADDRESS _ ✓ + CONNECTION D TA
CITY EL. N STA DEPT e /
MANNO REFERENCE _ _ UPPER
I ❑ STATE LOWER
REGISTRATION NO. COUNTY
NO. DESCRIPTION OF WORK FVE
HOUSESEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM -
Y. CURB P.W.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR 2 .
PITS ANO/OR GRAINFIELD @ $3.00OVERLOW SEEPAGE PIT. DAINFIELD ) 9
P.
EXTNFCESSPOOL,DRYWELLRMANHOLE @ $ 2.00 CO. IMP. NO. /.3J I „IOC O.HOUSE SEER CO
trY
PRIVATE DISPOSAL SYSTEMG TO @ S 1.00 TRUNK PERMIT NO. / ROAD PERMWWNO.
LRD'
ONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ '$1.00 PERMIT N0.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SE R OR DISPOSAL SYSTEM Q $L00 WASTE APPROVAL
V U � CHARGES �D�'a•�-/Cv� Y
CONNECTION CHARGE FEE
OWNER'S PERMIT
REIMBURSEMENT FEE -
THORIZATION TOTAL FEE o � O G
VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
HE PUBLIC SEW NEW HOUSE SEWER
ED THIS— DAY OF 19 CONNECT ADDITIONAL
ER OR BUILDING OR WORK OWNERS AGENT AGENT SEPTIC TANK,SEEP, PIT(S)
ESS AND/OR GRAINFIELD -
HEREBY ACK OW EDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
MBINGAND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OPDISCONNECT PLUG ANDNSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOPLUGAUSE D IFORNIA ORTHAT ELEGAL OW�4Bft--OF THE gBOVE SACPKFILL(SEP❑CCTANKS❑I ❑RIBED RESIDENTIAL OPE Y. / / /ATURE PERMITTEE
JOHN A. LAMBIE. COUNTY E ]NEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M.0. CASH '
wL04337� JAP21 5 25.00 �/