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Home My Public Portal About10218 DAINES DR_Sewer__ T A 4.- 76 Aj642D -CE808 -10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING D ADDRESS LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL I DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS O OF BLDG5 SIZE OF LOT y� �L NOW ON LOT CITY NO USE OF BUILDINGS OISTRICTNO GROUP BK MAP PG O ESSED BY CONTRACTOR '5'09 �� ADDRESS Z CO ECTION DATA CITY 0 A TEL NO T T '6 STATION DEPTH STATEr� LIC / MANHOLE REFERENCE YIPPER LICENSE NO15V Q �/ GLASS u LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRO HOUSE SEWER CONNECTING TO Y CURB P L M L TO P PUBLIC SEWER @ $7 00 P NO SEPTIC DANK SEEPAGE PIT OR CO IMP NO J NO PITS AND/OR DRAINFIELD @ SIO 00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO JR.(D RMIT NO O PRIVATE DISPOSAL SYSTEM @ S300 CONNECT ADDITIONAL BLDG OR OV AFFIDAVIT WAIVER -EASEY[NT O INSTR NO DATE V WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $5 00 O HWY OR ST WIDENING F- ALTER REPAIR OR ABANDON HOUSE V SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT {y1 MANHOLE 0 $7 00 PERMIT NO d INDUSTRIAL h WASTE APPROVAL Z OWNER'SPERMIT $ 3 00 CHARGES AUTHORIZA'T'ION TOTAL FEE 00 CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INS GTOR S IGNATURE SIGNED THIS DAY OF OWNER OR NEW HOUSE SEWER 44 OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREDAND/OR ALTER, REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWN R OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABO E DESC D RESIDEN IA PERT ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS El PERMTTTEE ❑ SEEP IT(S) ❑ CESSPOOLS UALIDATI , CK. M.O CASH L,J,o 9 4 6 5 r cc 12 6- 1 0 D 6.0 Of- "v SD CEAPPLICATION FOR ERMIT 1 cl:e08 oe east COUNTY OF LOS ANGELES SEWER-SEWA E DISPOSAL DEPARTMENT OF COUNTY ENGINEER ' BUILDING AND SAFETY DIVISION ITARESTILDING / _ DRESS /C) OHN A. LAMBIE. County En ees C SA1T D. GRIFFIN. Sup t of Building CALITY FOR APPLICANT TO FILL IN OSS ST.- LEGAL DESCRIPTION LOT NO. OWNER BLOCK, TRACT �f MAIL 6�2 ADDRESS / NO OF SLOGS. SIZE OF LOT d /b NOW ON LOT err CITY TEL. N0. USE OF DI DISTRICT NO. ROU MAP PR CESS BY BUILDINGS CONTRACTOR ` 'S K ` ADDRESS D ��JJJJ CONNECTION DATA CITY TEL.NO. 6 /O C� STATION • DEPTH REGISTRATION NO. /y7 / 1® STATE MANHOLE REFERENCE COUNTY / ' LOWER NO. DESCRIPTION OF WORK FEE Al HOUSE SEWER CONNECTING TO ' P-UBLIC SEWER @ $3.00 2-60 TYPE OF CONNECTIO LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.L.TO P.L. -S PITS AND/OR DRAINFIELD @ $3.00 - 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 NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. - ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1 00 ALTER,REPAIR DO R SYSTEM ABANDON HOUSE @ gt 00 STATE ENCROACHMENT SEWERPERMIT NO. INDUSTRIAL WASTE APPROVAL ' -CHARGES. OVVNER'■S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT DATE A CONTRACT WITH THE HEREINCON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTINGAMED DWELLING APPROVALS DATE INSPECTO 'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DA OF 19_ NEW HOUSE SEWER ttie OWNER OR CONNECT ADD[TIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) , AND/OR DRAINFIELD LCDESCRIBED HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR MBING AND SEWERS. SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND NSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER FORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS Cl RESIDENTIAL PROPERTY. SEEP.PIT(S ❑ CESSPOOLSATURE /PERMITTE •l• ®P VALIDATI ROBERT A. WOOD i CK. td p �gR SUPERVISING MECHANICAL ENGINEER 1 CE808 2/70 76A 642D APPLICATION FOR PERMIT '-7 1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ''LIII DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FEIT `J JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN'W JENKINS. SUP T OF BUILDING R APPLICANT TO FILL IN (PRINT OR TYPE ONLY) 7 LEGAL f DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT �� ADDRESS O NO OF BLDGS n JBY SIZE OF LO7 NOW ON LOT CITY L NO USE OFDISTRICT NO GROUP CLASS MAP PROCESSED BUILDINGS / B K �pJ� CONTRACTOR I� - I / /J ADDRESS /// CONNECTION DATA CITY TEL NO STATION DEPTH STATE LIC MANHOLE REFERENCE / LICENSE NO GLASS 6 � LOWER NO ,DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FRPM HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L PUBLIC SEWER a $5'00 PC NO SEPTIC (ANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD @ $1000 HOUSE SEWER CONNECTING TO / TRUNK PERMIT NO ROAD PERMIT NO } PRIVATE DISPOSAL SYSTEM nH $300 O_ CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIY[[ -EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD E%TN CESSPOOL OR YWELL MANHOLE @ $5 00 HWY OR ST WIDENING O ABANDON HOUSE SEWER SYSTEM 1300 STATE ENCROACHMENT V PERMIT NO U.1 INDUSTRIAL 91" WASTE APPROVAL hZ CHARGES OWNER'S PERMITs o0 AUTHORIZATION TOTAL FEE )v -CONNECTION CHARGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED ON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF I9_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS - BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ ,'[1PLUMBING AND SEWERS ° CESSPOOL DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR 1 LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM - CALIFORNIA OR tHAT 1 AM THE LEGAL OWNE OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE VE DESCRIBED ESI DEAL OPi!RTY - ABANDON HOUSE SEWER SIGNATURE BACKFILLSEPTIC TANKS ❑ OF PERMrrTEE A SEEP PIT 15) ❑ CESSPOOLS ❑ VALIDATION l JACK R. ALLEN CK M O SUPERVISING MECHANICAL ENGINEER CASH LAL0 2 7 0 61 0i 5 1 0 D 6.00-