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HomeMy Public PortalAbout10560 DANBURY ST_Sewer__ CE8603APPLICATION FOR PERMIT �D.StaO TSA saxD COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION HUILDIN JOHN A. LAMBIE. County Engineer ADOREss WILLIAM A. JENSEN. Supt of Building LOCALITY NEq REST FOR APPLICANT TO FILL IN CROSS AT, LEGAL ^ DESCRIPTION LOT NO, OWNER MAIL BLOCK TH O A,ORES.I (I / NO. OF BLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILD IN . DISTRICT NO. GROUP MAP PROCESSED BY _ BK PG CONTRACTOR / ADDREss CONNECTION DATA CITY �f TEL STATION 74, Q DEPTH TE pL© �� ❑ COUNTY MANHOLE DEFERENCE ) / V UPPER REGISTRATION NO. NO. F DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRdM ROUSE SEW EP CONNECTING TO Y. CURB p,l„ M.L.TO P.L. Q^J 7 / PUBLIC SEWER @ $5.00 SEPTIC TA N 1.1111—PIT OR P C NO O PITS AND/OR DRAINFIELD ® $10.00 CO.IMP. NO. JOB NO. U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT.NO. y� PRIVATE UISPOSAL SYSTEM @ 83.00 0 CONN ECT ADDITIONAL BLDG,OR AFFIDAVIT •Iv AMP Ni RECORD.INSTR.NO. DATE VF WORK TO HOUSE SEWER @ S3.00 U OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN..CESSPOOL,DRYWELL,MANHOLE@ $5.00 1 ALTER REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING N SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT Z PERMIT NO, INDUSTRIAL WASTE APPROVAL OWNERS PERMIT 5 z 00 CHARGES AUTHORIZATION TOTAL FEE70-6 N ONNECTION CHARGE FEE '1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCONREIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'SpIGNATURE SIGNED THIS Y IF14_ OWNEfl OR �/j NEW HOUSE SEWER OWNERS AGENT Yi! NEW HOUSE SEWER CON CT BUILDING OR WORK DDPE55 SEPTIC TANK.SEEP,PIT(5) 1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT HAT TME ABOVE ICORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REO IRED BY LOS ANGLES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA AT 1 AM THE LEGA OF AN INTEND TO HESIDE IN, E OVE DESCRIBE. MENTA PRO INTEND OIBCONNECT PLUG AND BANDON HOUSE SEWER SIGNATURE OF PERMI E / LL SEPTIC Tp NKE ❑ Sf EP,PIT / ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD I✓- SUPERVISING MECHANICAL ENGINEER CK, M.0. CASH [A(;02 0 7 4 e JM 31 1 0 D 7.0 0- n