HomeMy Public PortalAbout9432, 9434 DAINES DR_Sewer__ S&E-663 11.55
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE W SPOSA L
Department of County Engineer Y
County of LOS Angeles BUILD
Dr
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSING
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY' `
. -
FOR APPLICANT TO FILL IN CROSS'SrNEAREST. '� �•�' 1 .
LEGAL
DESCRIPTION LOT NO. 49 OWNER- Aa JI,Q
y' MAIL '
BLOCK TRACT �y Q N of )4 Q HCcS ADDRESS h
NO. OF BLDGS. .
SIZE OF LOT Jl NOW ON LOT CITYNO. 7,
USE OF < DISTRICT NO.. - GR`UP MAP
-BUILD[I NGS' 04"
yam. 17 BK PG ,
b CONTRACTOR _ - �d�/ '0
IJCr CONNECTION_ DATA
ADDRESS
STATION. DEPTH
CITY TEL. NO. ..
MANHOLE REFERENCE... - UPPER
❑ STATE LOWER
REGISTRATION NO. ❑ 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.TO•P.L.. .
SEPTIC TANK,SEEPAGE PIT OR � � � ��
PITS AND/OR DRAINFIELD _ Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL;MA N HOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. 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 y REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN Nfiftd 49P APPROVALS DATE_' -INSPECTOR'SSLGNATURE.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r.
TO THE PUBLIC SEWER. u - NEW HOUSE SEWER `
SIGNED THIS DAY OF 19. / CONNECT ADDITIONAL'
OWNER OR - BUILDING OR•WORK
OWNERS AGENT - SEPTIC TANK,SEEP, PITS) - ..
ADDRESS 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 SEW-ERS, 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 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
•
SIGNATURE SEEP.PIT(s) EJ CESSPOOLS❑
. -
OF PERMITTE - -
JOHN A. LAMBIE,. OUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR'
CASH -
1 6625- MiAR29 4 2.00 in