HomeMy Public PortalAbout10561 DANBURY ST_Sewer__ CEBOB 10-63 APPLICATION FOR PERMIT
J6A6420
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING `
I OHN A. LAMBIE. County Engineer ADDRESS / ,(J�.�/1
WILLIAM A. ]ENS EN, Supt o1 Building [l
LOCA Li TY
NEA REGT
FOR APPLICANT TO FILL N OSS ST.
LEGAL -i'Y�/ �'ri✓•
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ®
A.
/
SIZE OF LO NOW ON LOT CITY C TEL. NO.
USE OF — DISTRICT NO. GRO MAP PROCESSED BY
BUILDINGS
� r� BK PG
CONTRACTOR
ADDRESS ( (/C CONNECTION DATA
CITY 3 ` TEL. / 7 STATION DEPTH
I'��+, STATE �+ UPPER
REGISTRATION NO. LJ COUNTY MANHOLE REFER ENCE
I
N DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FqO
HOUSE SEWER CONNECTING TO /}..�T Y. CURB _ P,L. M.L.TO P.L.
PUBLIC SEWER $5.00
SEPTIC TANK,BEEPAGE PIT Dq P` NOS O
PIT$ANO/OR GRAINFIELD SIO.00 CO.IMP.NO. U
HOUBE SEWER CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT NO. y'
PRIVATE°ISPOSAL SYSTEM 53.00 ^
CONNECT AOOITIONAL SLOG,OR AFFIDAVIT uv As A.. RECORD.INSTR.NO. DATE V`
WORKTO HOUSE SEWER ® 33.00 iV•
OVERFLOW SEEPAGE PIT,GRAINFIELD
EXTN..CESSPOOL,DRYWELL.MANHOLE L5 $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING h
SEWER OR DISPOSAL SYSTEM ® $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OV✓NER'S PERMIT $ z 00
CONNECTION CHARGE FEE CHARGES
AUTHORIZATION I TOTAL FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXI TOWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIG NATURE
SIGNED THIS A OF 19_ /`�
OW NEROR NEW HOUSE SEWER �j
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION gryD/OR GRAINFIELD
AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICEN9EO AS REOU I BY LOS AN COUNTY AN STATE °F DISCO E DISPOSAL SYSTEM
C4LIFORNIA Ofl 1 AM THE LE WNER qN INTEND TO
RESIDE IN. ABO E DESCRIB BE GEN L PR RTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIG NgTUqCKFILL SEPTIC TANKS ❑
OPER I
F ( ❑
SEEP,PIT(S) ❑ CESSPOOLS
VALIDATIOI� ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
LACO2 0 1 o.W JUL 30 l o o 7.00-