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Home My Public Portal About10018 DAINES DR_Sewer__ 7aAE42D •- APPOCATIOfV FOR PERMIT 1 i S&E-88912.54 ,,DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of CountyEagiaADDRE ear County of LOS An:l BU'LD ISS NG WM.J. FOX, COUNTY ENGINEER a.� CASSATT D.GRIFFIN,SUP'7 OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST _ �r /}' q �• �.,,y CROSS ST. • �c ',ICYL,Gf!/'� LEGL DESCRIPTION LOT NO.s�,/l,�( OWNER - ' BLOCK TRACT ' ( � MAIL ADDRESS :54 C.�'OolJ'� Vy // NO OF BLDGS, g, _ SIZE OF LOT ,ry (8+'� e/ NOW ON LOT sL CITY TEL. NO. BUELDFNGS r .A, ' / DISTRICT N0. GROUP MAP CONTRACTOR V/ v �f% 114-1, I BK PG ADDRESS ,� �! . �t _' 'f-'f �.� CONNECTION DATA CITY f ,,9ie� STATION DEPTH El STATEREGISTRATION N0. L ❑ COUNTY ,��'L,� MAN�HOLERREFERENCE _ LOWER TYPE OF CO NECTION LENGTH FROM O NO. DESCRIPTION OF WORK FEE Y. 611991 P-WI-a M L.TO P L t HOUSE SEWER CONNECTING TO Y� A PUBLI C•SEW ER tail $ 3.50 ° HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG. OR CO. IMP, NO, deB"IN0. WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANK, SEEPAGE PIP OR --PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT $ 1 00 AUTHORIZATION TOTAL FEE c REIMBURSEMENT FEftE TRACTORHAVE T TOS CONNECT THEDATE AABODCTEE DESCRIBED BED EXISTINGWITH THE HEREIN A DWELLING G APPROVALS DATE INSPECTOR SSIGNATURE JO THE- PUBLIC SEWER NEW HOUSE SEWER SIGNED THIS - DAY OF / 19_ CONNECT ADDITIONAL OWNER OR OWNERS AGENT Y l-f BUILDING OR WORK r� SEPTIC TANK,SEEP, PIT($) ADDRESS AND/OR DRAINFIELD - IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL[3 _ AND'STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING `ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES C UNTY LAND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE-LEGAL NER F THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ,BACKFILL SEPTIC TANKS❑ SEEP,PIT(S) � CESSPOOLS SIGNATURE OF PERMITTEE Ohl WILLIAM J. FOX, COUNTY]ENGINEER VALIDATION ' �Uo 8 7 4 i' `� 'UL;f 4 Ir, BY By, DEPUTY DEPUTY B7 BY n + vy DbUTY ca DEPUTY t `6&E-6D `.B 3 E-863 12-54 APPLICATION FOR ■ EFtMIT 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County Of LOS Angeles BUILDING /O ADDRESO/ WM. J. FOX, COUNTY ENGINEER S L CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN ceoss STLEG . /Z p � fj GJ � AI n DESCRIPTION LOT NOnnPV!�21 , �� OWNER rl S o R. M .f? D R, G P r BLOCK' TRACTG_q,r�' rJ"4 MAIL BLDGS. n ADDRESS Z 4, !1f•��I�,� ,l� 9`i SIZE OF LOT NOWOON LOT /''� CITY TEL. NO. TPS L i USE OF BUILDINGS DISTRICT NO. I GROUP I MAP 8K PG CONTRACTOR Jr -� ADDRESS CONNECTION DATA V CITY TEL. NO. STATION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY UPPER LOWER TYPE OF CONNECTION LENGTH FROM NO. DESCRIPTION OF WORK FEE Y. - CURB P L. M L.TO P L HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $ 3 50 HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG. OR CO. IMP:NO. JOB NO WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO _ DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARGES p / CONNECTION CHARGE FEE PERMIT OWNER'S $ 1 00 / AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 HAVE THIS DATE CONTRACTED WITH THE -HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC-SEWER NEW HOUSE SEWER SIGNED THIS DAY OF 19- OWNER 'OR CONNECT ADDITIONAL - OWNERS AGENT BUILDING OR WORK SEPTIC TANK, SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3AND 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 PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT CT PLUG SEW D CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP.PIT(S) ❑ CESSPOOLS❑ SIGNATURE -7 OF PERMITTEEZ2Za a6 ` WILLIAM J. FOX, CouN ENGINEER VALIDATION TY DEPUTY �By ;p 17 4*1 By :® DEPUTY 0 DEPUTY