HomeMy Public PortalAbout10936 DANBURY ST_Sewer__ Te ' `P'9�r LI Vi9 1 ®Itl OR7ERMI 1
csaosoa s-ea COUNTY OF LOS ANGELES �.
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING Q
IOHN A. LAMBIE, CovatF Ea eer ADDRESS
CASSATT D. GRIFFIN, Sup 1 01 B.Hdivq LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CRDSS ST.
LEGAL OWNER
DESCRIPTION LOT NO.
BLOCK TRACT % MAIL
ADDRESS /
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT N0.~GROUP Y MAP ' I, PROCESSED BY
SUI LDI NGS BK
CONTRACTOR
ADDRESS 1 CONNECTION DATA I, '1
CITY TEL.NO. C? STATIONDEPTH D
q !4 PfiTATE MANHOLE REFERENCE
REGISTRATION N0. ,M 6/V ❑ COUNTY LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L N.L.TO P.L.
PITS AND/OR DRAINFIELD @ 33.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ S2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ 51.00
SEWER OR DISPOSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ Q 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS D' Y OF 19_ NEW HOUSE SEWER 0
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER.REPAIR.SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIO TWER
IAL PERT 1 BACKFILL SEPTIC TANKS CI
SIGNATURE eC—
SEEP. PIT(S ❑ CESSPOOLS ❑
OF PERMITTE
®' V)ILLIDATION ROBERT A. WOOD
cK. M.o. GSH SUPERVISING MECHANICAL ENGINEER
R;`2 4 1 72 JU' C 1 0 D 5.00