HomeMy Public PortalAbout10645 DANBURY ST_Sewer__ T
6
18A
E.63 APPLICATION FOR PERMIT
8& DIVi»ION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer ' • t I r �Y
County of Los Angeles BUILDING / O C� 7 7 r///�"NCJd YT/ -
JOHN A..LAMBIE• COUNTY ENGINEER ADD E55 //
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY fB.[ E r
_. ..-.
FOR LICANT TO FILL IN GROSS ST.
LEGAL OWNER
DESCRIPTION' LOT(y O.0 / 6Ar�r r 5L�Cr_
MAI
• AO REFS �7_ / �( /`1.p;> fl[;/•
BLOCK TRACT
- NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF
'DISTRICT N0. GROUP •• MA"—"C
• BUILDINGS
B
CONTRACTOR
ADDRESS �J` .� q CONNECTION DATA
CITY' �.1,d N`��, TE NO "'� i /. / STATION o`.�ol—b DEPTH
V J MANHOLEBEFERENCE LEPER
tE_STATE
W R
REGISTRATION N0. ' J LJ COUNTY ,
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM _
HOUSE SEWER CONNECTING TO So Y- CURB P.L. .L. TO P.L.
PUBLIC SEWER @ $.3.50 7
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ S 3.00 '/
OVERFLOW SEEPAGE PIT.DRAINFIELD CO. IMP. N0, lOB N0O �0 `/�
EXTN.,CESSPOOL,DRYWE LL,MANHOLE Q $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO, ROAD PERMIT NO. -
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSEINDUSTRIAL
SEWER OR DISPOSALSYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBVRSEMENT FEE
AUTHORIZATION ITOTAL FEE Y 15'e) '
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CDN- APPROVALS DATE I NSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING /��� , ♦ r
TO THE PUBLIC SEWER. T NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR I:W BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
ANHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
D STATE THAT dHE ABOVE 15 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 DISCONNECT PLUG AND
LICENSED AS REQUIRED' Y LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT/V AM THE LEGL OWNER OF THE ABOVE
DESCRIBED RESIOENTIp PROPERTY.�//)p � BACKFIL (SEPTI CESSPOOLS SIGNATURE rPW //
OF PERMITTEE / �
JOHN A. LAMBIE,, UNTY ENGINEER ALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK U. 0. CASH - -
a I,ACO20123- JM19 4 A - 450