HomeMy Public PortalAbout9703 DAINES DR_Sewer__ E808-D
CAPPLICATION �FOR-µPE IT -
eaoa a-sa COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPO AL
DEPARTMENT OF COUNTY-ENGINEER
BUMDING AND SAFETY DMSION BUILDING
ADDRESS 01
JOHN A. LAMBIE, County Engineer
CASSATT D. GBIFFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO MIN CROSS ST.
LEGAL
DESCRIPTION LOT NO OWNER
( MAIL
BLOCK
ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS AeDISTRICT N GROUP BK P6 MAP P ESSED Y
/►
CONTRACTOR Edi O
t
ADDRESS5L6/7COYMITION DATA
CITY TEL NO. STATION DEPTH
REGISTRATION NO STATE COUNTT MANHOLE RE RENCE G
OWER
No. DESCRIPT N F 0 K FEE
1 HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3 00 Y CURB P M L TO P L OG
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN ,CESSPOOL,DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1 00
CONNECT ADDITIONAL BLDG.OR TRUNK-PERMIT NO ROAD PE
WORK TO HOUSE SEWER @ $1 00
ALTER, REPAIR OR ABANDON HOUSE STAT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO
INDUSTRIA
WASTE APOVAL`
CHARGES
OwNER•S PERMIT s 12100 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 6 40 REIMBURSEMENT FEE
I 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 SEWER.
SIGNED THI _DAY OF 1966 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK '
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIO
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
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
CALIFORNI OR THAT 1 AM THE LEGAL OWNER OF THE ABO
DESCRIBE TIAL PROP Y. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) CESSPOOLS
OF PERMITTE
®R �mATION " ROBERTA WOOD
CK m o, CASH SUPERVISING MECHANICAL ENGINEER
I,_11-f'0 4 9 0 5.0 H