HomeMy Public PortalAbout10642 DANBURY ST_Sewer__ ESOB 1n
CAPPLICATION FOR PERMIT .
casae a-BT COUNTY OF LOS ANGELES
_ SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION RAREST DING -
JOHN A. LAMBIE, County Engineer ESS >' 2
CASSAir D. GRIFFIN, Sup.I of Building
LITY
FOR APPLICANT TO FILL IN " .
LEGAL
DESCRIPTION LOT NO. OWNER - -
BLOCK TRACTC MAIL -
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF - -
BUILDINGS DISTRICT NO. GROUPMAP
CONTRACTOR `�' r I B _pG
ADDRESS a CONNECTION DATA -c�J
CITY TEL. N0. - , STATION DEPTH
TATE MANHOLE REFERENCE PP
' REGISTRATION N0. J 4' LJ COUNTY447
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO :�J d`
PUBLIC SEWER @ $3. .7
SEPTIC TANK,SEEPAGE PIT OR -- TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB M.L.TO-P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TOP.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 Zg�
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUMINERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCRO
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERSPERMIT $ 00 CONNE ON CHARGE FEE
AUTHORIZATION TOTAL FEE QO REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN-NAMED CON- -'
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS D TE INSPEC R'S SIGNATURE
TO THE PUBLIC SEWER. - _ _ - _ a
SIGNED THIS OF I9 NEW HOUSE SEWER
OWNER OR ------ - - - CONNECT ADDI TI ON AL - �-Y- -'� - — - '- -
OWNERSAGENTz/ / BUILDING OR WORK
ADDRESS-'" - -- - - - "- --- -SEPTIC-TANK,SEEP,.PIT(S)--_
AND/OR'DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE-ABOVE-IS CORRECT-AND,AGREE-TO COMPLY - —CESSPOOL0- DRYWELL❑- --- - -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
T HEREBY-CERTIFY'THAT I AM PROPERLY REGISTERED ANO/O R- -SEWA GE.DISPOSAL SYSTEM-
LICE NSED
YSTEM-LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE'OF DISCONNECT PLUG AND
CALIFORNIA OR THAT_1 THE .LEGA ER-OF_THE. E - ABANDON HOUSE SEWER
DESCRIBED REST DENTIA ARTY. _ BACKFILL SEPTIC TANKS ❑
SEEP. PITS) (]CESSPOOLS [ISIGNATURE
OF PERMITTE
- -VALIDATI��,ONppp.AAA_�sssxxx �\/// _. ROBERT A.WOOD'.____-_ _ _...
- CK.___x.0. -SUPERVISING MECHANICAL ENGINEER
- - � 02 1`8 6FEB 41-0-A- - 5:00 'n -
9-66 APPLICATION FOR PERMIT g
5&6420
S& II.S9
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL'
Department.of County Engineer
County of LOS Angeles . BUILDING iq. -
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS J O /_ ya( l7lir� 'l U I-y
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY `7—•p ;v.p(-p C
� • NEAREST '
£OR APPLICANT TO FILL IN CROS, ST.
LEGAL OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK -TRACT ADDRESS /A- 0•. C! do
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
q
CONTRACTOR 4 "3/b /+rl
ADDRESS ��`.� (AU E � } �'�l CODEPTH CONNECTION DATA -
// r `
CITY y(� 0„ T•(, TEL. NO. is2
STATION i ,
r� ) (rY C} MANHOLE REFERENCE
L. 1�7 - UPPER
//
REGISTRATION NO. S�� LI COO TY .
NO. DESCRIPTION TYPE OF CONNECTION LENGTH FROM �I
HOUSE SEWER CONNECTING
WORK FEE
TING TO !^ y,- ) CURB P.L. M.L.TO P.L, �f
PUBLIC SEWER @ $3.50 / t 1
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PLT, DRAINFIELD P. C. NO. /
EXTN.,CESSPOOL.DRYW ELL,M AN HOLE @ $2.00 F CO. IMP. NO. JOB N0, y' /', O y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $t.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $i.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES { /
CONNECTION CHARGE FEE
'OWNER'S PERMIT 5 1 00 REIMBURSEMENT FEE' / llf"Er,l �I
AUTHORIZATION TOTAL FEE S
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS /I" E INSPECTOft'S,IGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. 'NEW HOUSE SEWER. '
SIGNED THIS DAY OF19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TNIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR rDISCONNECT PLUG AND
I LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I/AROM THE LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTI PPERTY. BACKFILL SEPTIC TANKS❑
1 SIGNATURE �O ,.
SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTE W
JOHN A. LAMBI%COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
/ CK U.0. CASH -
[AC0 2 0. 7 4 A JUM 2 0 4 A
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