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HomeMy Public PortalAbout9717 DAINES DR_Sewer__ SE-6D APPLICATION FOR PERMIT 'DIVISION a 'DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING Q JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 1 ® CASSATT D GRIFFIN, SUP T of BUILDING LOCALITY �j-'t,pL NEAREST �4� FOR APPLICANT TO FILL L IN CROSS sT. LEGAL DESCRIPTION LOT NO OWNER t7l C, F1?lQ4,—D MAIL _ BLOCK -TRACT t � ADDRESS NO OF BLDGS CITY TEL, NO _ SIZE OF LOT NOW ON LOT USE OF BUILDINGS DISTRICT NO GROUP MAP �,� I I CONTRACTOR t L K PG ADDRESS -`ILWIC �t N �q CONNECTION DATA CITY © TEL NO l / •Z� STATION DEPTH MANHOLE REFERENCE UPPER �F [4­fTATE REGISTRATION NO •"^L ❑ COUNTY No DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM Y CURB -P M L.TO P L PUBLIC SEWER @ $3 50 �� SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3 00 OVERFLOW SEEPAGE-PIT, DRAINFIELD CO IMP NO 108C.NO EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 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 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSI NATURE: 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 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ WITHALL COUNTY ORDINANC D STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT AM OPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED LOS GELES COU ppI• Y AN STAT OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM LEGAL OW(E OVE DESCRIBED RESIDENTI Y ♦' BACKFILL PIT SEP ❑ CESSPOOLS SIGNATURE OF PERMITTEE _ ^ JOHN A LAMBIE, COUNTY ENGINEER LIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR N O CASH - - - - - - LACO 5 1 1 8- DEC 16 4. 4-.5 0 M