HomeMy Public PortalAbout9435 DAINES DR_Sewer__ ceeoe-e-sa COUNTY''OF LOS ANGELES '
SEWER-SEWAGE DPSPOSAL-
DEPARTMENT OF COUNTY ENGINEER •. M
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. 7,AMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building ` LOCALITY
y ,:n-' NEAREST
FOR APPLICANT TO"FILL IN ceoss sr..
LEGALe?ezq
DESCRIPTION °LOT WOO OWNER
BLOCK ,T MAIL' _ ` •
ADDRESS' '
_ qO.I OF BLDGS.
SIZE OF LOT '_° ,`'NOW ON LOT I CITY TEL.NO.
USE OF
BUILDINGS
DISTRICT NO. GROUPI MAP PROCESSED BY
CONTRACTOR r �^' K P6 s
ADDRESS,,�rB - 'CONNECTION DATA
cl TEL. NO. ,j'�s, STATION. 32�• Z." DEPTH'
�j STATE MANHOLE REFERENCE, PH
REGISTRATION NO. LOWER
No. DESCRIPTION OF WORK FEE ..
HOUSE SEWER CONNECTING TO '
PUBLIC SEWER @ $3.00 0,0 s"
e SEPTIC TANK, SEEPAGE PIT OR TYPEOF`CO LENGTH FROM C
PITS AND/OR DRAINFIELD., @ $3.00 Y. RB P.L. - M.L.TO P.L. 3 s-
.PITS
SEEPAGE PIT, DRAINFIELD `
EXTN.,CESSPOOL,DRYWELL,MANHOLE- @ $2.00
HOUSE SEWER CONNECTING TO P.C. N0.'.
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 _ 8
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE-ENCROACHMENT
PERMIT NO.
INDUSTRIAL• `
WASTE APPROVAL •'
CHARGES
OWNERS pggMlT $ 2 DO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 141 196 REIMBURSEMENT FEE
a 1 HAVE AT THIS'DATE A CONTRACT WITH THE HEREIN NAMED CON: APPROVALS.. .. DATE INSPECTOR'S SIGNATURE
TRACTOR'TO CONNECT THE ABOVE DESCRIBED'EXISTING DWELLING
TO THE PUBLIC SEW ���/ �Q
SIGNED THISAY OF �I9 .y NEW HOUSE SEWER= (a ii
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT r' BUILDING OR WORK •,
SEPTIC TANK, PIT(S)
ADDRESS - AND/OR.DRAINFIELD
• I- HEREBY AC NOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[I DRYWELL El
STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING y ALTER, REPAIR,SEWER:OR -
PLUMBING AND SEWERS. SEWAGEDISPOSAL 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 THE LEGAL OWNER OF THE .ABOVE'
DESCRIBED RESIDENTIA ' PERTY. BACKFILL SEPTIC TANKS[I
SIGNATURE SEEP.PITS) ❑ CESSPOOLS
OF PERMITTE
Or /—XALIDATION ROSERTA.WOOD
CK. / M.o.- CAsFt SUPERVISING-MECHANICAL ENGINEER
LACE 7 '7 5.87, A -5.00 , �..