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HomeMy Public PortalAbout9815 DAINES DR_Sewer__ F808 D ceaoe APPLICATION FOR PERMIT a-sa COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DIVISION BUILDING ADDRESS - TOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Supt of Building LOCALITY 4?_Qz NEAREST ' FOR APPLICANT TO_FILL IN CROSS ST. LEGAL ` OWNER DESCRIPTION LOT NO. - BLOCK TRACT ! �b � MAIL , ADDRESS NO OF BLDGS. ` SIZE OF LOT NOW ON T CITY TEL N0. USE DI DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS I BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY EL.N0. STATION t DEPTH ,. / STATE MANHOLE REFERENCE REGISTRATION NO. �'v COUNTY , LOWER NO. I DESCRIPTION OF WC5RK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @,$3 00 TYPE OFCTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. URB 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 P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1 00 ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNFR'.S' PERMIT S 2 00 ,CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE ,REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTI9G•DWELLING APPROVALS DATE 'INSPECTOR'S SIGNATURE' TO THE PUBLIC SER)t.� SIGNED THIS _QFFY OE 19_ NEW HOUSE SEWER J OWNER OR ,,/� CONNECT ADDITIONAL OWNERS AGENT Af- BUILDING OR WORK ` ADDRESS SEPTIC TANK,SEEP.FIT(S) 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 ALTER,REPAIR,SEWER OR - PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIR D BY LO ANGELES COUNTY AN STAT OF BANDON HOUSE SEWER CALIF RNIA OR THA I A 19E LE L OWNER HE VE DESC R ENT R BACKFILL SEPTIC TANKS ❑ / SIGNA E 6 f SEEP.PITS) ❑ CESSPOOLS tet?' OF PERMITTE ®o VALIDATION, ROBERT A. WOOD CK: M.0. CASH SUPERVISING MECHANICAL ENGINEER Fps 5 8 8 p fJ�R 31 'v A 6-00•