HomeMy Public PortalAbout9963 DAINES DR_Sewer__ S IN E•869 11.58
DIVISION OF .BUILDING AND SAFETY SEWER-SEW E ®ISP® L
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
VN
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO–F/ILL IN CRO REST
LEGAL OWNER
DESCRIPTION LOT N0. O
MAIL
BLOCK TRACT /3 gQ ADDRESS IN
OF BLDGS. /J CITY C r TEL. NO.
V SIZE OF LOT NOW OM LOT
USE OF DISTRICT NO. GROUP BK MAP
-' BUILDINGS .
PG
CONTRACTOR 17 -
ADDRESSlaop;Z�A�;/f 9p CONNECTION DATA
? CITY EL. N0. f/l MANHOLE l •r9 DEPTH
/� •�
�I,/ FERENCE s.
d' JTATEOWE
REGISTRATION 0. O Ff/ ❑ COUNTY
NO. DESCRIPTION OF O K FEE
TYPE O�GAtFil✓ TION LENGTH FROM
HOUSE SEWER CONNECTING TO Y.
/ CURB P.L. M.L. TO P.L. ' Q
PUBLIC SEWER @ $3.50 ♦,
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD ^7 '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 jp
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT �—
WORK TO HOUSE SEWER @ $1.00 PERMIT NO. •1 '
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 FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITHkTHHEREIN NAMED CON- APPROVALS DATE- INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT T E ABOVE DESCEXISTING DWELLIN
TO THE PUBLIC SE NEW HOUSE SEWER-
' � �-
SIGNED THIS DA O n 1 CONNECT ADDITIONAL
OWNER OR ... - BUILDING OR.WORK
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(S)
ADDRES f AND/OR DRAINFIELD
1 HER BY ACKNO EDGE THAT I HAVE EAD IS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT HE ABOVE IS CORRECT REE 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 REGIS ERED AND/OR p4SCONNECT PLUG AND
LICENSED AS R OUIRED Y Ip6S AN LES COU AND OF ANDON HOUSE SEWER fj
ALI FORNIA O AT h_THE' GAL OW OF ABO
I�EU RE E D. AqKSETP.FPIT(S) El CESSPOOLS
(FRE t
O ERMITT
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD.. CHIEF PLBG. INSPECTOR
CK. M.Q.-
. 088 —
.. O88 — FEB 1'Q 4' A 550 O m