HomeMy Public PortalAbout9707 DAINES DR_Sewer__ 5&E-886 9 11-58 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING•AND SAFETY SEWER—SEWAGE DISPOSAL.
Deportment of County Engineer
County of Los Angeles BUILDING O� _:DA
I N E'<,a
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JOHN A LAMBIE, COUNTY ENGINEER ADDRESS ►t a C o�
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITfIg M PL EZ C IT ,
FOR APPLICANT TO
�FyI.LL IN NCR s. B ASE L R S T���T
LEGAL
DESCRIPTION LOT NO '�i OWNER F ( `r te+ EQ-9 Lj
MAIL
BLOCK TRACT i �1 /A r� ADDRESS y -
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP MAP
K PG
CONTRACTOR t L f C.g. r -
ADDRESS C P_ CO TION DATA '
STATION DEPT
QH
CITY , TEL. NO
MANHOLE REFERENCE _
�� STATE
REGISTRATION NO ( LOWER ,
C ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
PUBLIC SEWER @ $3 50 5L Y. CURB P L M L TOP L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $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 Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO-
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
,
AUTHORIZATION TOTAL FEE 0 REIMBURSEMENT FEE "
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPEC•TOWTSTG A URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING q
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL , 0
OWNER OR BUILDING OR WORK - ` -
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)-
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 SEWERS SEWAGE DISPOSAL SYSTEM
•I HEREBY CERTIFY THA PROPERLY REGISTERED AAD/OR
LICENSED AS REQUIRED L ANGELES CQ NTY ND S E OF DISCONNECT PLUG AND
CALIFORNIA OR THAT A HE kEGAL ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDEN L P PERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE - '
JOHN A LAMBIE. COUNTY ENGINEERVALIDATION ROBERT A WOOD. CHIEF PLBG INSPECTOR
K N O CASH
' UCo 5 1 1 61; DEC 1,6 -4 - 4.50 -