HomeMy Public PortalAbout9944 DAINES DR_Sewer__ S76A6420
E-683 11•SS APPLICATION FOR PERMIT 1
B&E•6 -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depm eat of County Engineer
County•of Los Angeles BUILDING r
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS �� � ��(/`L•ef� �✓ ' i
® CASSATT D GRIFFIN. SUPT OF BUILDING LOCALITY
_ a.L
FOR APPLICANT.TO FILL IN ' ceoss sr.
LEGAL C Q OWNER '
DESCRIPTION 401 NO,` OWNER
(JJ
BLOCK �.15 J 47 T /3 r _ MAIL
i
ADDR_ ESS' (7
l i NO. OF BLEL. NO
SIZE OF LOT � NOW ON LOTT CITY T — -
USE OF
BUILDINGS _ DISTRICT NO., GROUP MAP
/ S BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS
STATION •Q DEPTH
CITY �� TEL- NO. ��� MANHOLE REFERENC - _ J UPPER
2- I ATE
REGISTRATI N0, O 2-, [],COUNTY
-
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM P L M L.TO P.L
PUBLIC SEWER, '-'t,�,s ,• @ $3 50
. CURB ^J
Y
SEPTIC TANK,SEEPAGE PIT%OR'
PITS AND/OR DRAINFIELD @ $-3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P -
NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP. NO a� JOB,NO
HOUSE SEWER CONNECTING TO n Q
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO. - ROAD PERMIT NO a
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 !J !! PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE P INDUSTRIAL-
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARG
_ CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE 917
REIMBURSEMENT FEE,
I HAVE-AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE IN ECTOR'SSIGNATURE
TRACTOR-TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWERI NEW HOUSE SEWER
SIGNED THIS DAY OF ' �" 19`J CONNECT ADDITIONAL
OWNER OR Q/ BUILDING OR WORK _
OWNERS AGENT �'��'n' /_� L' SEPTIC TANK,SEEP,PIT(S)
ADDRESS ��T"^�" �` •�A• AND/OR DRAINFIELD
1 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 -THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE.0 ABANDON CT PLUG AND
CALIFORNIA OR THAT .�,AN THE�EGAL OWN OF TH ABOVE,
HOUSE SEWER
/pEy$�G/RI(QE-q" RESI E/JT OPERT) BACKFILL SEPTIC TANKS❑
'S(F�GNATO•RE � / O, SEEP.PITS) ❑ CESSPOOLS I fie.•- �"'"�
OF PERMITTEE ,
�MMOM�Ojgj� gag 6169 01696996
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
r CK I nn 1A11
G 3 FEB
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