HomeMy Public PortalAbout10202 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGl EER SEWER—SEWAGE DISPOSAL 10 9 21
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
• COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER I BUILDING
ADDRESS D 6a
FOR APPLICANT T//O/FILL IN LOCALITY
BUILDINGADDRESS/[/p�. Dm6. i(7( (/�y /�/LP� )S_27, NEAREST
L/ CROSS ST.
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO.
s A IFo � ? S
NEAREST
CROSS ST i
RECEIVED BY Ready for Inspection DATE
ISSUED
OWNER f J/Li I T
MAIL 11
ADDRESS USE ZONE OCCUPANCY BK MAP PG
CITY -� TEL.NO.
P
CONTRACTOR California Sewer"/Con-,tt,Co- CO.IMP.NO. /L/L f
ADDRESS 1317 Colegrove Ave JOB.N0.
CITY Montebello TEL.NO.UNion 1-5n4A, TRUNK PERMIT NO.
STATE
REGISTRATION NO. 104445 S QMANTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT INDUSTRIAL
N0.OF BLDG3. ( WASTE APPROVAL
SIZE OF LOTI� I,^- XD NOW ON LOT 1 CHARGES
USE OF n
13UILDINGS y� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO.�I DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTIO CORDED
WORK TO HOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR_DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM - 1 00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR /
_ PITS AND/OR_DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL - /�
SPECIAL CONDITIONS ONLY 2.003 �- JHANEr- UHOLE PPER REFERENCE
TYPE OF CONN CT LENGTH FROM s� f
OWNERS PERMIT $ I 1 00 V. P'L� M.L.TO P L. of-J
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED ,
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING 1 APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PLIC SEWER �► Q 1%
SIGNED THISDAY OF...-.- ge .....19;5,3 NEW HOUSE SEWER
CONNECT ADDITIONAL t'
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP.PIT(S)
ADDRESS.. - rljl w/t AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- -CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBEDESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE /U SEEP.PIT(S)F] CESSPOOLS
OF PERMITTEE -•.1-" --
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