HomeMy Public PortalAbout10650 DANBURY ST_Sewer__ 'BAB` °
CEBOB 11-57 APPLICATION FOR PERMIT `),
COUNTY OF LOS ANGELES $EWER—SEWAGE:DISPOSAL. ,
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION
TORN A. LAMBIE, County Engineer ADDRESS �u • )
CASSATT D. GRIFFIN. Supt of Building
_ LOCALITY A
FOR APPLICANT TO FILL INceoss.T.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
AOORESS
N0.OF SLOGS. _
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS 'Z DISTRICT NO. GROUP MAP
CONTRACTOR I,- BK P6
15
ADDRESS ti - CONNECTION DATA
CITY TEL. N0. 7 J 3je STATION �, DEPTH
REGISTRATION N0, Z. T� COUNTY MANHOLE REFERENCE P
NO. DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3. OO -
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELO @ $3.00 1 Y. CURB .L. M.L.TOPA.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE IS $2.00
HOUSE SEWER CONNECTING TO P.C.NO. •�
PRIVATE DISPOSAL SYSTEM $1.00 �q.lyp�.Mp �pp.Hs
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
1 ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT -
PERM i0. JJJ
INDUSTRIAL 1/
WASTE APPROVAL rjy
CHARGES
OWNER'S PERMIT
$ JI 00 k CONN ECTIO HARGE FEE 1
AUTHORIZATION I TOTAL FEE Co
REIMBURSEMENT FEE
f HAVE AT DATE A- O .
TRACTOR TO CIONNECT THE ABO ET EISCR BED EXISTTHE IING DWELLING vAPPROVALS DJLTE INSPECTO)rS SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF -� -� 79 NEW HOUSE SEWER /OWNER OR
ORLJON
4 --- CONNECT ADDITIONALERS AGENT \ BUILDING OR WORK
- -- - - \ - - .SEPTIC TAN K,SEEP, PIT($)-AND/OR DRAINFIELDHEREBY ACKNOWLEDGE THREAD THIS APPLICATION STATE THAT THE ABOVE IT AND AGREE.TO COMPLY -CESSPOOL-❑ EYWELL ALL COUNTY ORDINANCTATE LAWS REGULATINGBING AND SEWERS. ALTER,REPAIR.SEWER ORHEREBY CERTIFY THAT I RLY REGISTERED AND/OR - SEWAGE.DISPOSAL SYSTEM-NSED AS REQUIRED BY LOS COUNTY AND ST TE OF DISCONNECT PLUG AND'
FORNIAOR THAT I ' N .OF T _ABOVE ABANDON HOUSE SEWERRIBED RESIDENT[ . PEBACKFILL SEPTIC TANKS 0SEEP. PITS) ❑ CESSPOOLSATURE > �� -
PERMITTE
`- .VALIDATION - - _ ROBERT-A:WOOD__
CK. _ M.O. .-- ASH SUPERVISINGMECHANICALENGINEER-
- tjCD2 I s 7� FEB -4 1 0 A 5.00- ; -
9&..20
E-66 APPLICATION FOR PERMIT
6 H IL55 -
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depmtment of County Engineer
County of Los Angeles BUILDING //��
.JOHN A. LAMBIE. COUNTY ENGINEER ADDRESSX/-
® - CASSATT D. GRIFFIN, SU P•T°F BuaglNc LOCALITY
FOR APPLANT TO FILL IN ceoss
ICsr.
LEGAL
n DESCRIPTION LOT NO. OWNER iN•!1 S•S° L
MAIL
BLOCK TRACT ADDRESS
NO.OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USE
BUILDINGS
DISTRICT NO. GROUP MAP
A
4
CONTRACTOR BK PG
R/
,e a QST �+
ADDRESS LZ- S -W As' F .19•a- CONNECTION DATA
CITY �_;V�,r
TEL. NO. Y, _�` e,yQ S STATION rj - DEPTH
MANHOLE REFERENCE UPPER
REGISTRATION NO.
/6 P S� o COUNTY
- NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ` - �.'1 TYPE OF ECTIONGH P.L.M
CURBP L. M.L.Nd
PUBLIC SEWER @ S 3.50 ,J J ,�y`��
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00-
OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. NO• Ll�u
EXTN.,CESSPOOL,DRYW ELL,MAN H OLE Q $2.00 CO. IMP. NO. JOB NO. 7
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 $1.00 - PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM CN $1.00 '- WASTE APPROVAL
CHARGES �CIAJ
CONNECTION CHARGE FEE (/' Y
OWNER'S PERMIT 8 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
�a
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS VAfIDATE INSPECTOR'S SIGNATURE
TRACTOR
RTO CONNECT SEWER. NEW
ABOVE DESCRIBED EXISTING DWELLING
TOTHE PUBLIC
NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT;ADDITIONAL
OWNER OR BUILDING OR WORK -
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I -HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL D DRYWELLD
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 AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON HO PLUG PLUGUSE D
CALIFORNIA OR THAT I AM HE LEGAL"OWNEft OF THE ABOVE _
ER
DESCRIBED RESIDENTIAL PRO ERTY. BACKFILL SEPTIC TANKS D
' SIGNATURE j�i 7 SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE -
JOHN A. LAMBIE.CO NTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
CK M. 0. CASH
M2 0 7 3'm� JW2 Q- 4 A 4.5.0