HomeMy Public PortalAbout10557 DANBURY ST_Sewer__ J �l
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>6A APPLICATION FOR PERMIT
6A642D 642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION auaDwG
JOHN A. LAMBIE, County Engineer ADDREss S'7 /I/
WILLIAM A. JENSEN, Sup'1 of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN GRD55 5T.
LEGAL
DESCRIPTION LOT NO. OWNER
AIL
BLOCK TRACT HI ADDR
NO. OF B DG5.
SIZE OF LOT NOW ON LOT / CITY ,TEL. NO.
USE OF
BUILDINGS DISTfl ICT NO. GRO MAP PROCESSED BY
1 � ^, BK PG _
CONTRACTOR (
ADDRESS Z. V CONNECTION DATA
l/
CITY s TEL. N STATION / , f . DEPTH
y ATE MANHOLE REFERENCE �•/
REGISTRATION NO. (/ Ll COUNTY - 9- ( /I crl
-ZOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTI LENGTH FRO
H005E SEWER CONNECTING TO Y. CURB P,L. M.L.TO P.L. }
PUBLIC SEWER @ SS.00
P C °
SEPTIC TANK,SEEPAGE PIT OR CO.IMPNO. aNir. J� D O
PITS ANO/OR GRAINFIELD @ SIO.°O . alien /
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ 53.00 w
CORN"
CT ADDITIONAL BLDG.OR AFFIDAVIT 'WAIVER 1410EXT RECORD,INSTR.NO. DATE O
WORKTO HOUSE SEWER @ S3.00 1-
OVERFLOW SEEPAGE PIT.GRAINFIELD W
EXTN..CESSPOOL.DRYWELL,MA RHO LE' S5.°O d
ALT ER.REPAIR OR ABANDON HOUSE HWY. OR SL WIDENING y
SEWER OR DISPOSAL SYSTEM @ 83.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $l 2 lD�o '
AUTHORIZATION TOTAL FEE VV CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREI AMED CON. REIMBURSEMENTFEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST NG DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OW HER OR �j NEW HOUSE SEWER 7-306f! 0
OWNERS AGENT n
CONNECT ADDITIONAL U
BUILDING OR WORK
OGRESS
SEPTIC TANK.BE13)
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION pryO/OR GRAINFIELDHELD
ANDSTATE THAT THE ABOVE 15 CORRECT AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATETE LAWS REGULATING
PLUMBING AND SEWER$. CESSPOOL ❑ DRYW ELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REG15T RED AND/OR ALTER, REPAIR,SEWER OR
LICENSED AS REGU E° BY LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR T T 1 AM THE LEGAL OWNER F. D INTEND TO DISCONNECT PLUG AND
RESIDE IN, TI/ OVE DESCRI°EO IGEN L P OPERT.Y.
IJ// �J ABANDON HOUSE SEWER
SIGNATURE
PERE p BACKFILL SEPTIC TANKS ❑
OF FERMI T ❑
SEEP,PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CAS
L&2009JM30 1 0 D 7.00