HomeMy Public PortalAbout9426 DAINES DR_Sewer__ 78A842D canoe B-59A
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COUNTY OF LOS ANGELES ERM
SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER <. :a
BUILDING AND SAFETY DIVISION 11 BUILDING
ADDRESS `+
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
.:....,._.�,� ..�, NEAREST
' FOR APPLI�4N�TQgFILL IN ceoss sTie ORLEGAL .
DESCRIPTION LOT NO. � ,7n'l/7-.7 _�
t wOWNER
BLOCK TRACT (41 �� , 1�Q - MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL..NO.
USE OF .. ..,3;,_:..,,� r..._: n,,,. .r. •. ..,:....
BUILDINGS DISTRICT NO. GROUP BK PG MAP PROCESSED BY
CONTRACTOR �j I I
ADDRESS �' _, CONNECTION DATA
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CITYTEL.NO. J STATIONz3 d_ DEPTH
STA E
REGISTRATIO N0. COUNTY MANHOLE REFERENCE 1l ��/ UPPER
LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF N CTION LENGTH FROM
SEPTIC TANK,SEEPAGE,PIT OR Y. CURB PL. M.L.TO P.L.
. PITS.AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
1. .ALTER,REPAIR OR ABANDd N HOSE STATE ENCROACHMENT -
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
_. WASTE APPROVAL
CHARGES
OWNER'S PERMT $ 2OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
Y DATE A CONTRACT WITH THE HEREINAMED CN-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE,PUBLIC SE ER.r A
SIGNED THIS, OF 1946 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL "
OWNERS AGENT�o BUILDING OR WORK
ADDRESS �•' SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT 1 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'
r i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - DISCONNECT PLUG AND -
LICENSED AS REQUIRED BY LOS ANGELES'COUNTY' AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE L G OWNER OF THE ABOVE
ILL SETIC TANKS
DESCRIBED RESIDENT 5ROPE SEEPBACKFPIT(S)P❑ CESSPOOLS
SIGNATURE - -
OF PERMITTE
®" ALIDATION ROBERT A. WOOD
X.o. CASH SUPERVISING MECHANICAL ENGINEER
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