HomeMy Public PortalAbout10653 DANBURY ST_Sewer__ APPLICATION FOR PERMIT
W1,ION BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcmtment of County Engineer ^" . 11
County of Los Angeles BALD E S /' / /
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 10 O.(p �T Q
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY r. /yI
7DESCRIPTION
PPLICANT TO FILL IN CR s$
/
NO. OWNER I kF L ('MAIL
CT ADORES$ 7N0.OF BLOCSCITY TEL. N0.
NOWON LOTDISTRICT NO. GROUP MAP
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r T f�
CONTRACTOR n �5 `Vp � frj_ �!` pL ..L.
�rJ CONNECTION DATA
ADDRESS 1-4- 5-7,w i/rd C s STATION / � J . DEPTH
CITY Z'{ ll,J��./ G TEL.�NO�l ('/YDS' MANHOLE REFERENCE 1 rJ PPE
REGISTRATION N0. ❑ COUNTY '
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO YPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 ,CURB P.E. M.L. TOP.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD Q $3,00 C
OVERFLOW SEEPAGEPIT,GRAINFIELD CO. IMP. NO. JOB NO. -T J 0
OVERFLOW
SEEPAGE
PIT, L,MAN ISLE Q $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM C $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 Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
St '
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN DN-
- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGG DWELLING
E FEEICONG O
TO THE PUBLIC SEWER. 6_ NEW HOUSE SEWER 41 7
SIGNED THIS DAY OF IL U 1" C 19 5_a CONNECT ADDITIONAL
OWNER, OR BUILDING OR WORK
OWNERS AGENT I��C�
SEPTIC TANK,SEEP, PITS) '
ADDRESS ANO/OR DRAIN FI ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLlCAT10N CESSPOOL❑ DRYWELL D
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 D15POSAL 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 1 AM THE LE AL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY/ BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(5) ❑ CESSPOOLS❑
OF PERMIT1,CEEA
JOHN A. LAMBIE. CPLNTY ENGINEERVALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
�K.LGN. NO 2 9"k J"14 A 4.50 -'M