HomeMy Public PortalAbout10937 DANBURY ST_Sewer__ >s
'BAB`?p APPLICA IOM FOR OERMIT
CEBOs 0.EB
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER .. - - . .... -
BUILDING AND SAFETY DIVISION RUILmnG
ADDRESS
JOHN A. LAMBIE, County. E wear d
CLO
D. GRIFFIN, Sup t of Building LOCALITY
NEAREST 1 1
FOR APPLICANT TO FILL IlV caoss ST. � l
F
EGAL �J
RIPTION LOT NO. % OWNER d '
K TRACT 'j—/3 �, MAIL
ADDRESS
N0.OF BLDGS.
OF LOT NOW ON LOT CITY TEL. NO.
OF
DINGS DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR
t I BK 2 PG
y ADDRESS ! CONNECTION DATA
CITY "'I EL.NO J 6 6 STATION _ DEPTH
ATE MANHOLE REFERENCE
REGISTRATION NO. -� COUNTY 1 A _T LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNELTIO! LENGTH FROM it
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L. V
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.. CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.'NO. JOB N0. r
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ S1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER.OR P'SPOSAL SYSTEM HOUSE @ $1.00STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
5 OWNERS PEAMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE ) ' REIMBURSEMENT FEE
' 1 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 DAY OF 19� NEW HOUSE SEWER -Z&/cv llv" .'l
OWNER ORONNECT ADDITIONAL
A
' OWNERS AGENT /�// BUILDING D 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 CESSPOOL ❑ DRYWELL El ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR _DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
CT PLUGHOUSE AND
CALIFORNIA OR THAT I AM THE GAL OWNER OF THE ABOVE
DESCRIBED RES TIAL PERT Y i BACKFILL SEPTIC TANKS ❑
SIGNATf
SEEP.PIT(S) ❑ CESSPOOL
URE S ❑
OF PERMIT
®' VALIDATION ROBERT A. WOOD
CK, I{I ,:4 H.O. CASH SUPERVISING MECHANICAL ENGINEER
b!JY 2 1 yV' Ju:d ,-2 0 1'� D J .v