HomeMy Public PortalAbout10639 DANBURY ST_Sewer__ ]GA -
C66 APPLICATION FOR PERMITe& DkVISION OF BUILDING AND SAFETY SEWER—SEWAGEDISPOSAL
.Deportment of County Engineer - -
<'• County of Los AngeleseuLLDTNG ')
JOHN A. LAMBIE. COUNTY.ENGINEER ADDBES'
5 u l-J
® CASSATT O. GRIFFIN. SDP'T oa BmLDIrvG
LOCALITY �.vAn {- C-
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. 14 ( fAGJT0 J , OWNER 64A4 S' �.p,r� /
BLOCK TRACT ADDRESS_ ,? s3 7
NO. OF CLOGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS // DISTRICT NO. GROUP yI MAP
BK PG
CONTRACTOR A 6A
ADDRESS L 5 L.1 /�r x>i wyj e Q CONNECTION DATA
CITY /rvt A tiM TEL. N� �.�` S 1�QS STATION r �Z,� 0- DEPTH
/ (/' MANHOLE REFERENCE P
f 6 IJ s ,� ❑ COUNTY
REGISTRATION NO, 91
NO, DESCRIPTION OF WORK FEE
TYPE OF CONNECTION - LENGTH FROM
HOUSE SEWER CONNECTING TO d Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.501
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00 - c•�
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. N0. JOB N0. J
EXTN.,CESSPOOL,DRYWELL,M AN HOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $ 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $JNG
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT 1 00
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE
Sv APPROVALS DATE INSPECTORS SIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19— CONNECT ADDITIONAL 4 '
OWNER OR /0 C/ &'IBUILDING OR WORK
OWNERS AGENT SEPTICTANK,SEEP, PIT(S)
-ADDRESS ANO/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT i HAVE READPPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT ANDTO COMPLYWITH ALL COUNTY ORDINANCES AND STATE REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY RED AND/OR ONNECT PLUG ANOLICENSED AS REQUIRED BY LOS ANGELES COUO STATE OF ABANDON HOPLUGAUSE DCALIFORNIA OR THAT AMTHE LEGA OWNTHE ABOVEDESCRIBED RESIDEN�A PROPERTY. BACKFILL SEPTIC TANKS❑SIGNATURE SEEP.PIT(S) [_1 CESSPOOLS L),
OF PERMITTEE
JOHN A. LAMBIE. LINTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PL.BG. INSPECTOR
..... ".....-t._.
CK.0I1,0. CASH "
(p20 2 4,- jW 19 4"A 4;50 M