HomeMy Public PortalAbout10946 DANBURY ST_Sewer__ '°"642" APPLICA IOINV FOROERMIT
cseae+e-se 'COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMHIE, County. Engineer ADDRESS
CASSA7
7 D. GRIFFIN, Sup t of Building LOCALITY
NEAREST
FOR APPLICANT TO, FILL IN CROSS ST.
LEGAL OWNER
[SIZE
CRIPTION LOT N0.
CK - TRACT _ a, .MAIL
ADDRESS
NO.OF SLOGS.
OF LOT NOW ON LOT CITY TEL.11 NO.
EOF -ILDINGS DISTRICTNO. GROUP BK MAP PG PROCESSED BY
NTRACTOR DRESS 1� CONNECTION DATA
? CITYTEL.NO. ��C STATION DEPTH �.
rSTATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ;?— COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO "
PUBLIC SEWER @ $3.00 h TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB L.
M.L.TO P.L. Z
PITS PND/OR DRAINFIELD @ $3.00
1 OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO. s
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO. G
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO:
EPAIR OR ABANDON
SEWER OR DIISPOSAL SYSTEM HOUSE @ $1.00 STATEENCROACHMENT
PERMIT N0,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT S 2 OO CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT N.
TRACTOR TO THIS
THE ABOVE DESCRIBED ED C
BEHE ERE I
D EX I STTH THE NNGAOWELLMED �NG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS F 19 NEW HOUSE SEWER
F OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
[AND
DRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELLTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
UMBING AND SEWERS. GE DISPOSAL SYSTEM1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
CENSED AS REOUIREO BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
LIFORNIA OR THAT I AM THE L GAL OWNER OF THE ABOVESCRIBED R NTIAL OPERTY _ BACKGNATURE
SEEP.PITS) ❑ CESSPOOLS ❑
OF PERMI
®r LID - ROBERT WOOD
0. CAS
Y.O. H SUPERVISING MECHANICAL ENGINEER
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