HomeMy Public PortalAbout9956 DAINES DR_Sewer__ 76AG42D APPLICATION "FOR PERMIT
B&E-663 11-55 `
"DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
DepciIr ent of County Engineer
County of Los Angeles L
ING /1
JOHN A LAMBIE, COUNTY ENGINEER SSCASSATT D GRIFFIN, SUP T OF BUILDINGITY
MUMFOR APPLICANT TO FILL IN ceoss sr
LEGALA/ OWNER
DESCRIPTION LOT NO _/
/ �O S MAIL
BLOCK TRACT ADDRESS
N0. OF BLDGS CITY TEL NO
SIZE OF LOT 0 f.V NOW ON LOT
�L
USE OF DISTRICT NO. I GROUP MAP
BUILDINGS
BK PG
CONTRACTOR _ 07 r– A7—"I
CONNECTION DATA
ADDRESS
w
STATION DEPTH
CITY TEL. NOUPPER `
- MANHOLE REFERENCE _ _ ,
Cl STATE - LOWER
REGISTRATION NO. ❑ COUNTY h NO DESCRIPTION OF WORK FEE
TYPE OF QNNECTION LENGTfi4ROM
HOUSE SEWER CONNECTING TO Y. C P L M L,,FO P.L.
PUBLIC SEWER @ $3 50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELDC. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP. NO. 27 J 0
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PER T NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHM T -
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM @ $1 00 - WASTE APPR VAL
CHARGES
CON ECT10N CHARGE FEE
OWNER'S PERMIT $ 1 00'
AUTHORIZATION TOTAL £EE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING '
TO THE PUBLIC SEWER. NEW HOUSE SEWER - -
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL'
r BUILDING OR WORK
OWNER OR _
OWNERS AGENT SEPTIC TANK,SEEP,PIT,(S)
ADDRESS
AND/OR DRAINFIELD `
1HEREBY ACKNO EDGE 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. PIT(S) ❑ CESSPOOLSf,..�.r
OF PERMITTEE
JOHN A. LAMBIEktOUNTY ENGINEER VALIDATIO A. WOOD, CHIEF PLBG. INSPECTOR
CK. b 0. ASH _
? C0:37 0 70BERT
Rrj4_ 2.0 0 �'
&E-6D
IS83 11•SS APPLICATION FOR PERMIT .
8&E-8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE .DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS s .
LEGAL }/ OWNER
DESCRIPTION LOT NO 7 -
d MAIL
BLOCK TRACT �,•�00� - ADDRESS '
SIZE OF LOT /NOW OON LOTS CITY l TEL. NO
USE OF DISTRICT NO. GROUP MAP
BUILDINGS '
' / BK PG
CONTRACTOR �(/y
ADDRESS LIP.
CONNECTION DATA "
/ 'STATION DEPTH
CITY TEL. NO. MANHOLE REFERENCE UPPER
REGISTRATI N0. ���0/12,' ❑ COUNTY ` R
NO' DESCRIPTION OF W RK FEE
O TYPE OFCTION LENGTH FROM rj
HOUSE SEWER CONNECTING TO Y. CURB 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. 106 No,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
/ CONNECT ADDITIONAL BLDG ORSTATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 - WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH T E HEREIN NAMED cON- APPROVALS/' DATE INS, CTOR'SSIGNATURE
TRACTOR TO CONNECT THjpABOVE DESCRIJFED EXISTING DWELLING
TO THE PUBLIC SEWER. - / NEW HOUSE SEWER
SIGNED THISAY OF 1852 .,e CONNECT ADDITIONAL
OWNER -OR - s` Lf BUILDING OR WORK - - -
OWNERS AG NT _ SEPTIC TANK,SEEP,PIT(S)
ADDRESS t,e •�' ,,"'.ys AND/OR DRAINFIELD
1 HEREBY ACKNOWLED E THAT I HAVE REA 'THIS APPLICATION -
",AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELLO� ,
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 -
ICENS£D AS REQUIRED BY LOS A GELES CO TY AN STATE OF ABANDON HOUSE SEWER
ALIFORNIA T A 1 THE EGAL ER, OF AB
CR RE ID ® BACKFILL SEPTIC TANKS❑
S G ATURE t SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE A _
JOHN A LAMBIE, C UNTY WNGINEER VALIDATION ROBERT A.WOOD;CHIEF PLEIG. INSPECTOR
CK. ( ,�.3 4A55 7 r, FEB 2 4 4 5.5 0 �'