HomeMy Public PortalAbout9334 DAINES DR_Sewer__ -61
76A642 G�111 P 1��\JUST M N FOR I('E I1�1 M Il
76A 642D �J
COUNTY OF LOS ANGELES SEWWE RSEWAG ppSpOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO r H 0'41 � OWNER 1021'-7�
BLOCK TRACTS pi'�,zis,- ., E . MAIL
dJ'`�j• �J F �/'�� ADDRESS
NO.OF BLDGS. �i
SIZE OF LOT NOW ON LOT CITY TEL. NO d
USE OF DISTRICT NO. GROUP MAP PRO
BUILDINGS 0 PG CESSED BY
CONTRACTOR � ��.-
ADDRESS ^� /--- J CONNECTION DATA
CITY TEL.NO _ 4T1O1N DEPTH
�• ® LE REFERENCE UPPER
REGISTRATION NO. COUNTY LOWER
NO. I DESCRIPTION OF _WORK IrEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,
PITS AND/OR DRAINFGE DT OR @ $3 00 Y. CURB P.L. M.L.TO P.L.
1 OVERFLOW SEEPAGE PIT,DRAINFIELD >-
EXTN..CESSPOOL.DRYWELL @ 32.00 d
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ S1.00 O
SEWER OR DIISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL "LY
WASTE APPROVAL d
N
CHARGES z
OtlMER'S PERMIT 51 "2 00 CONNECTION CHARGE FEE
AUTHOMATIO1g I TOTAL FEE 131— REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPRO�/A DTE INSPEGTOR'S'SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ - NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT «l"� BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT U HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑.
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 HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER 'OF THE ABOVE
DESCRIBED RESIDENT I L ROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE
����)�EEP ( ❑ CESSPOOLS
OF PERMITTE "
VA1MATIO� ROBERT A. WOOD
CK. ff.0. cAsx SUPERVISING MECHANICAL ENGINEER
Lffi 6 2 :6 5 �' gEC "�..� 0 p 5.00 ...
5-
70
76A642D.61 /SII °I! ��C/n1T�M V FOR PERIIVII� Il
76A 64
COUNTY OF LOS ANGELES SEWER-SEWAGE ®QSP®SQL
DEPARTMENT OF COUNTY ENGINEER . -_
BUILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE, County Engineer ADDRESS. �✓
WILLIAM A. JENSEN, Supt of Building_ LOCALITY
- - ' NEAREST
FOR APPIICANT TO Pc'I%I. IN CROSS ST.LEGAL �
DESCRIPTION LOT NU' �, OWNER lis'
MAI L
BLOCK TRACY. y+ P y�e A <9 ADDRESS
(O.OF BLDGS. yea /7
SIZE OF LOT NOW ON LOT CITY TEL. NO
LEGAL
USE OF
BUILDINGS . '� DISTRICT N0. GR-)O'UUP� MAP PROCESSED BY
CONTRACTOR I B �
ADDRESS CONNECTION DAT
CITY TEL.NO. � gp�/&�, S T N '_� DEPTH
STATE ANHOLE EFERENCE_._ -
REGISTRATION NO. -7 G � ® COUNTY , LOWER'
NO. DESCRIPTION OF _WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $5.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB, P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD >_
EXTN..CESSPOOL.DRYWELL @ $2.00 d
HOUSE SEWER CONNECTING TOP.C.NO. / O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0.
WORK C H ADDITIONALUSE LDG.OR @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER RR DAIR O ABAL ANDON HOUSE @ $1 00 STATE ENCROACHMENT - 0
A� PERMIT NO. U
(� DJ
� v�v INDUSTRIAL a
WASTE APPROVAL �� N
CHARGES 4
?
OvR ER'S PERMIT $ CONNECTION CHARGE FEE
AiTTgIORIZATIORT I TOTAL FEE f REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPRO\IAImS DA TO 'S SIGGNN'A/TOUR-E
TO THE PUBLIC SEWER.. _q,
j/G^ /7
SIGNED THIS DAY OF 19- -'; NEW HOUSE SEWER
" OWNER OR CONNECT ADDITIONAL
OWNERS AGENT, ! BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT tHAVE READ THIS APPLICATION
' AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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,l M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI L IAOPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PITS ❑ CESSPOOLS
OF PERMITTE
VAIMATIOROBERT A. WOOD
CK. 11.0. WH SUPERVISING MECHANICAL ENGINEER
06266\ DEC 19 1 D 2 5.0 0 �p.