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Home My Public Portal About10941 DAINES DR_Sewer__ 7GA84ZD APPLICATION FOR PERMIT S 6 E-863 11-SS DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer _ County of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ' ADDRESS © CASSATT D. GRIFFIN, SUa T OF BUILDING LOCALITY FOR APPLICANT T ,FjLL ICT caoSS ST. LEGAL Y 5 DESCRIPTION LOT NO. OWNER MA ' BLOCK TRACIL T b ^ , ADDRESS - N0.OF BLDG?., A/ CITY TEL. NO. SIZE OF LOT NOW ON LOT USE DI DISTRICT�- GROUP MAP BUILDINGS ^>� _.- �� CONTRACTOR C V G � CONNECTION DATA ADDRESS / STATION DEPTH (� CITY EL. NO. 2,3 MANHOLE REFERENCE 0 ' 'It' 6 '/1�� STATE WER REGISTRATION N0. �.j(7 ❑ COUNTY NO. DESCRIPTION OOFF''VORK TEE TYPE OF TION LENGTH FROM HOUSE SEWER CONNECTING TO CURB � M.L. TO P.L. PUBLIC SEWER @ $3.50 O SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. N0. JOB NO. EXTN..CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0, ROAD PERMIT NO.�� CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT S 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE S/1 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 1 APPROVALS DATE INSPECTOR'SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED-EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS DAY OF 19 p ,,/Anon CONNECT O WORK OWNER OR �i�J/ /n �1 Imo-/A BUILDING OR IVORK ' OWNERS AGEN j (�C [ADIf�O /7 SEPTIC TANK,SEEP, PIT(S) -ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ pRYW ELL❑ 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 DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSES EWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ yy / GNATURSEEP.PIT(SJ SIGNATURE IE ❑ CESSPOOLS© ,/'��J ( �f�,' -,-.,�-, I OF PERMITTEE M !I JOHN A. LAMBIE. COUNTY ENGINEER It 4LIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR (CRS Y.0. CgSN .P. o0494- J1_'L2 4 4.50 ID .