HomeMy Public PortalAbout9702 DAINES DR_Sewer__ $aE-6 911-s$ APPLICATION FOR PERMIT 1
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE- DISPOSAL
Department of County Engineer
County of Las Angeles ' BUILDING j>_ 2' l�gjVCt5 -7-
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS �7
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY /1fTAL L- I NEAREST
�• �i -�
FOR APPLICANT TO FILL IN CROSS ST.LEGAL
/
DESCRIPTION ' LOT NO OWNER
BLOCK' TRACT- - MAIL
DDRESSNb -OF BLDGS CITY TEL N0.
SIZE OF LOT NOW ON LOT
USE OF -
BUILDINGS DISTRICT NO GROUP
I - MAP
PG
CONTRACTOR
ADDRESS (,��C] CONNECTION DATA
STATION DEPTH
CITY O V TEL NO / /
MANHOLE REFERENCE /
` ❑ STATE LOWER
REGISTRATION NO C1 COUNTY
NO DESCRIPTION OF WORK FEE
TYPE'OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y- CURB P L M L TO P L.
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
ITS AND/OR DRAINFIELD -Q $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 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 $ 1 00
AUTHORIZATION TOTAL FEE 1.5
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INlSP.ECTOR„SSIGN•ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL /
OWNER OR BUILDING OR WORK _
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ,
ADDRESS AND/OR DRAINFIELD -
1 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 &ALOPERTY
SEWAGE DISPOSAL SYSTEM -
I HEREBY CERAM PROPERLY REGISTERED D/OR DISCONNECT PLUG AND '
LICENSED AS RES ANGELES OUNT ATE OF ABANDON HOUSE SEWER
CALIFORNIA OR HE LEGA OF THE ABOVE
DESCRIBED RESIDBACKFILL SEPTIC TANKS❑SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑ -
OF PERMITTEE 1 "
JOHN A LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD. CHIEF PLBG INSPECTOR
CK q 0, CASH - - -
',ACp5 1 2 4-, DEC 16 4 4.50 M