HomeMy Public PortalAbout9325 DAINES DR_Sewer__ S SAE48 3.1 f-55 (I-'U P II tls�C 0^U T�O �l 11 O[I tl P E 11 tl 11 G Il Il T _
DIVISION.OF BUILDING AND SAFETY EWER-SEWAGE DISPOSAL
Department of County Engineer ;I;: ,.
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.
JLEGAL �xy OWNER
. DESCRIPTION LOT'NO.
g MAIL
BLOCK ,TRACT.- /��. ADDRESS /
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
x
USE OF
'i BUILDINGS f �f` tA,� r„ DISTRICT NO. GROUP MAP
BK PG
CONTRACTORy L'^ � S
CONNECTION DATA
ADDRESS ��" ���N W��.I.a
Lc--!s
� `D�c�C.} � A C) STATION l y DEPTH
(�
` CITY TEL. N0. (y 4�,J �
MANHOLE REFERENCE. / (,, o ( (UPPER
``,, / STATE i L" l
REGISTRATION NO. C Ste" 7 COUNTY _
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIO LENGTH FROM jZD
HOUSE SEWER CONNECTING TO S"� Y. CURB P.L. M.L. TO P.L. P
PUBLIC SEWER @ $3.50 J
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.. ,* j 44
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO. j (0
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $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 $ 1 00
AUTHORIZATION' TOTAL FEE I ts
REIMBURSEMENT FEE
I HAVE-.AT THIS DATE A- CONTRACT•WITH THE HEREIN NAMED CON- APPROVALS DATE INSPEGTOR'SSIGNATURE
TRACTOR TO CONNECT.THE ABOVE. DESCRIBED.EXISTING DWELLING
TO THE PUBLIC SEWER. /� Com' NEW HOUSE SEWER ��
SIGNED THIS ' �2— DAY OF k `AP+c-i"� 19en�
CONNECT ADDITIONAL
OWNER. OR - BUILDING'OR WORK
OWNERS AGEN / - SEPTIC TANK,SEEP, PITS) _
_ADDRESS a a;2,9 -' � d AND/OR DRAINFIELD ""-
I 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
P HEREBY CERTIFY THAT I 'AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND '
LICENSED AS REQUIRED L S ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT MT E LEGAL" OWNER OF THE ABOVE
DESCRIBED RESIDENT P OP - BACKFILL SEPTIC TANKS❑
` SEEP.PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD: CHIEF 1.PLBG. INSPECTOR
CK, m.0. CASH
I 'll' 4087 mAR13_ 4 4 .50
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