HomeMy Public PortalAbout9406 DAINES DR_Sewer__ 20
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL aI7�
Deportment of County Engineer =
County of LOS Angeles BUILDING?' C� n
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS -
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ��
FOR APPLICANT TO FILL IN CROSS ST.
LEG-'- DESCRIPTION LOT NO. OF—&� 7'
OWNER
MAIL r
BLOCK - - TRACT - ADDRESS ' 9014 � -
NO. OF BLDGS. CITY L. NO.
SIZE OF LOT�Sxll 7 NOW ON LOT
USE OF G DISTRICT NO. GROUP MAP
BUILDINGS
P
y P .
CONTRACTOR,:.-4�T I �� ;Zea P
CONNECTION DATA
q ADDRESS 23 `..
CITY %���%/ TEL. NO. �� STATION D �S c DEPTH
� „ MANHOLE REFERENCE UPPER
A—STATE LOWER
REGISTRATION N0. �•`�� �� ❑ COUNTY
NO. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION_ -LENGTH FROM .
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. 'i0 P.L.
SEPTIC TANK,SEEPAGE PIT OR a -
PITS AND/OR DRAINFIELD c@i $'3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN-.,CESSPOOL,DRYWELL,MANHOLE @ $2:00 CO. IMP. NO. JOB-NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 S TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
4} WORK TO HOUSE SEWER Q $1.00 ��/ , PERMIT NO. _
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM n $1.00 WASTE APPROVAL -
CHARGES
CONNECTION-CHARGEFEE -
OWNERS PERMIT $ 1 00
Ann
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE.
v� .1 APPROVALS DATE INSPECTOR'S SIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING /{,,� - / Jf
TO THE PUBLIC SEWER. NEWHOUSE SEWER = J� 1/k'1A�_�G Ma
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR — BUILDING WORK
OWNERS AGENT (/`� SEPTIC TANK,SEEP(PIT(S) '
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONCESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,c — _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING P 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 IAM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE y SEEP. PIT(S) ❑ CESSPOOLS El
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N.0. CASH -' - -