Loading...
HomeMy Public PortalAbout10568 DANBURY ST_Sewer__ CEBW '10.63APPLICATION FOR PERMIT T6A642D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION *00HESG �.0�6 JOHN A. LAMBIE. County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCgLITV NEq REST FOR APPLICANT TO, FILL IN RO55 ST. — — C� EGAL /) DESCRIPTION LOT NO. OWNER �✓ •//, MAIL (� BLOCK TRACT �! O ADORE 5� NO. OF SLOGS. ee�� SIZE OF LOT NOW ON LOT CITY TEL. NO. VSE OF n DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS � // / BE PG / - CONTRACTOR AV e2 %J /'� 1, e u (�/� (-Ft. �._. CQ C7 ADDRESS ,-�--/y CONNECTION DATA CITY q/ TEL. NO. STATE STATION ©� '?/ DEPTH ❑ / �)h REGISTRATION NO. O��V/ ❑ COUNTY MANHOLE REFERENCE cp/ I'V LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRO / HOUSE 5EWER CONNECTING TO ,O� Y. CURB P.L. M.L.TO P,L. } PUBLIC SEWER ® SS.O° r/V P.C.NOCL SEPTIC TANK.SEEPAGE PIT ON . O O PITSAND/OR.EAINFIELC ® SIO.00 CO. . . J IMPNOOB NO. j1°USE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, PRIVATE DISPOSAL SYSTEM QP $3.00 R' CON NECT ADDITIO NAL BLDG,OR AFFIDAVIT I WAIVE. 1E.G,l RECORD.INSTR.N0. DATE O WORK TO HOUSE 5EWER ® $3.00 OVERFLOW SEEPAGE PIT,GRAINFIELD W E%TN..CESSPOOL,ORYWELL.MA NH O LE $5.00 D_ ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING w SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT Z PERMIT NO. I NOUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT s 2 00 I AUTHORIZATION TOTAL FEE 7 G� CONNECTION CHARGE FEE .1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR. SIGNATURE SIGNED THIS DAY 019_ OWNER OR NEW ROUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.FIELD PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 RR C RANO THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IE CORRECT S ANO AGREE E COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ pRYW ELL ❑ IHEREBY CERTIFY A 1 AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR LICENSED AS REOUI D Y LOS ANGLES COUNTY4STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH 1 M THE LEGAL OWNER OF. NTEND TO 015CONNECT PLUG ANO RESIDE IN, THE O OESCRIBEDR,ENTIA TY. ABANDON HOUSE SEWER SIGNATURE [//// BACKFILL SEPTIC TANKS ❑ OF PERMITT ❑ ❑ CESSPOOLS VALIDATION ROBERT A. WOOD CK. M.0. DASH SUPERVISING MECHANICAL ENGINEER [ACO2.0 7 5e JUL31 1 0 0 7.00- N