HomeMy Public PortalAbout9809 DAINES DR_Sewer__ 76A642D A P L I C AT O N FOR PERMIT
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ceeoe e.se COUNTY OF LOS ANGELES .�.
SEWER-SEWAGE DIS OSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FT
JOHN A. LAMSIE, County Engineer CASSATT D. GRIFFIN, Supt of Building
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT 3 &V _
ADDRESS
NO OF BLDGS.
SIZE OF LOT NOW ON LOT" Z CITY TEL NO
USE OFm
BUILDINGS r (9."rd •� DISTRICT NO GROUP BK MAP P PROCESSED BY
!� G �
I
CONTRACTOR /,s.c Q G
ADDRESS y A/.), rdY-C CONNECTION DATA'
CITY TEL NO STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO a COUNTY LOWER
No I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO "
PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y CURB P L M L.TO P.L.
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO Pt NO. '
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO.
WORKCONNECT ADDITOUSEIONAL
SEWER BLDG OR @ Si 00 TRUNK PERMIT NO ROAD PERMIT
ALTER R{�A*"N HOUSESTATE ENCROACHM
SEWER OR-D SP9SALST-
YSEM @ $1-0 " PERMIT NO '
INDUSTRIAL
WASTE APPROVAL,-"
CHARGES
OWNERS PERMIT $ - 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ) REIMBURSEMENT FEE
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDAA CONTRACT WITH THE IINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEVJ�R,.
SIGNED THIQA)r OF D 1946 NEW HOUSE SEWER
OWNER ORj�Jyy`_ CONNECT ADDITIONAL
OWNERS AGENT n / BUILDING OR WORK
ti "*1 19 - v SEPTIC TANK,SEEP PIT(S)
ADDRESS Pa
AND/OR DRAINFIELD '
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY •CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS•REGULATING
PLUMBING AND SEWERS ALTER,REPAIR,SEWER OR
O /�(i6
1 HEREBY CE RTI THAT 1 A PROPERLY REGISTERED AN /OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REOU RED B LOSANG S COUNTY ST ISCONNECT PLUG AND
C ORNIA 0$ T 1 r.T'HE L L OWNER F H 0 E BANDON HOUSE SEWER
DESC S E T BACKFILL SEPTIC TANKS ❑
SIGN R f SEEP PIT(S) ❑ CESSPOOLS
OF PERMIT I
®� VAIMATIO ROBERT A WOOD
CR. H.G. CASK SUPERVISING.MECHANICAL ENGINEER
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