HomeMy Public PortalAbout9951 HOWLAND DR_Sewer__ E-6D
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DIVISION OF BUILDING AND SAFETY SEWVER-SEWAd..E O USPOSAL rl�i
Deportment of County Engineer . 1 1
County of Los Angeles BUILDING oajC�j✓1> /�. .
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS r
® CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT ADDRESS
{� NO. OF BLDGS, � CITY TEL. N0. 7�
SIZE OF LOT -V (7 NOW ON LOT
USE OF - �..
BUILDINGS DISTRICT NO. GROUP - MAP
5--- � �P
CONTRACTORS 42
ADDRESS
CONNECTION DATA '
�,- /a /
.STATION ,D PTH L�
CITY TEL. N0. MANHOLE REFERENCEUP ER
❑ STATE L R
REGISTRATION NO, ❑ COUNTY S
0
No. DESCRIPTION OF WORK FEE
TYPE OF CONNEC ON L'ENGT FRO
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50 Y- CURB 1.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELDP, C. NO:
EXTN.,gESSPOOL,DRYWELL,MANHOLE @ $2.00 r CO, IMP. NO. �' ®� 10B"NO.
HOUSE SEWER CONNECTING TO ° a
PRIVATE DISPOSAL SYSTEM @ $1.00 " TRUNK PERMIT NO.: - ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER . @ $1.00 PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @_ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGEFEE
OWNER'S PERMIT 1 00
REIMBURSEMENT FEE -
AUTHORIZATION. I TOTAL FEE JW
,
I HAVE 'AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- .�APPROVALS DATE INSPECT,OR'S'STGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - f TO THE PUBLIC SEWER, _ - NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK -
OWNERS AGENT - -
SEPTIC TANK,SEEP, PIT(S) '
ADDRESS AND/OR'DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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 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 AM THE LEGAL ER OF THE ABOVE
DESCRIBED RESIDENTRO BACKFILL SEPTIC TANKS❑
SIGNATURE TV�`������ SEEP. PIS) Ll CESSPOOLS❑ -
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
VALIDATION "-
CK. M.0. CASH
s�' 1
2 7 6���` 1.0 4 4.50 :a