HomeMy Public PortalAbout10938 DANBURY ST_Sewer__ CE8082B-59 APPLICATION FO PERMIT .
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DNISION BUILDING
ADDRESS ,L
JOHN A. LAMBIE, Cot P Engineer -
CASSATT D. GRIFFIN, Supt of Building, LOCALITY
NEAREST
IC
FOR APPLICANT TO FILL IN "0. ST.
LEGAL
I� OWNER
DESCRIPTION LOT N0, v
BLOCK TRACT MAIL
ADDRESS
NO.OF BL G .
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE DI DISTRICT N0. GROUP MAP PROCESSED BY
BUILDINGS Q I BK PGI
CONTRACTORIL
aoDREss2 CONNECTION DATA
CITY TEL.N0. �3 STATION DEPTH
•
REGISTRATION NO. ATE MANHOLE REFERENCE ^ UPPER
COUNTY 1 .Li'(ilAi
No. I 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. M.L.TO P,L, -
PITSAND/OR DRAINFIELD @ 53.00 _
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P,C.NO.
PRIVATE DISPOSAL SYSTEM @ $1,00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @51.00
SEW ER O R D,P09A L SYST EM HOUSE @SLOO STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 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 INSPECTORS SIGNATURE
TO THE PUBLIC SEWER. p ,`
SIGNED THIS d
AY OF 19_ NEW HOUSE SEWER -/,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL I]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR.SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID TIAL OPERTYBACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP. PIT(S) CICESSPOOLS ❑
OF PERMITTE
®' / VALIDATION ROBERT WOOD
(
CK./ M.o, G15N SUPERVISING MECHANICAL ENGINEER
I t:o 2 4 1 UPJ 2 0 z D 5.0 0 ri .