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HomeMy Public PortalAbout9833 DAINES DR_Sewer__ 76A642D - APPLICATION FOR PERMIT S&E-669 11.55 DIVISION OF BUILDING AND SAFETY ; SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles - BUILDING J 1:> PIN I JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 'j ^ ® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY NEAREST FOR APPLIC�rANT TO FILL IN CROSS ST. �✓ � / LEGAL / OWNER DESCRIPTION LOT NO C.P �- MAIL BLOCK TRACT /3 ,� S ADDRESS ` ,J { NO. OF BLDGS SIZE OF L �C l O a NOW ON LOT CITY TEL NO USE OF DISTRICT NO. GRO P MAP BUILDING BK PG CONTRACTOR r �p ADDRESS CONNECTION DATA fE� STATION /© A a (/-� DEPTH I TEL NO. MANHOLE REFERENCE UPPER ❑ STATE _ REGISTRATION N0. C:1 COUNTY NO DESCRIPTIO OF WORK FEE - TYPE OF CTION LENGTH FROM HOUSE SEWER CONNECTING TO '�// y, URB P L M L.TO P L PUBLIC SEWER @ $3 50 �! 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 @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO O CONNECT ADDITIONAL BLDG OR - A STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 41V PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL CHARGES _ CONNECTION CHARGE FEE OWNER'S PERMIT S 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREI AMED CON- APPROVALS DATE NSFCTOR'SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE E NEW HOUSE SEWER tydp SIGNED THIS DAY OF ] CONNECT ADDITIONAL, OWNER OR r •BUILDING OR WORK - •• OWNERS AGENT • -� SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY A NOWLEDGE 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 THAT •1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND CALIFORNIA OR I AM THE LEGAL OWN E OF THE ABOVE _ DESCRIBEWER D RES NTI L PROPERTY BACKFILLSEPTIC TANKS❑ SIGNATURE SEEP PIT(S) ❑ CESSPOOLS OF PERMITE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR cK i t 2 8 1 7� Mov 2 8 4 550 �'