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Home My Public Portal About10228, 10224 DAINES DR_Sewer__ e CEO 08 12-68 APPLICATION FOR PERMIT 7°A °42D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION TNEAREST DLo'RESNG S a JOHN A. LAMBIE, COUNTY ENGINEER Z COLEMAN W. JENKINS. SUP T OF BUILDING -� A L)TY 0:1 y"� FOR APPLICANT TO FILL IN SS ST LEGAL �• DEBCRIPTION LOT NO J OWNER JESSF�D MAILBLOCK `� TRACT ADDRESSNO ��+y+��SIZE OF LOT /p NOWOONB LOGTB CITY I �"' TEL NO.'S '�VUSE OFDISTRICT NO GROUPMAP PR BUILDINGS BK PG CONTRACTOR ADDRESS CONNECTION DAT CITY TEL NO STATION _L `7 DEPTH T G i STATE LIC MANHOLE REFERENCE QUPPER LICENSE NO CLASS LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTI LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD SIO 00 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO r PRIVATE DISPOSAL SYSTEM 3300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMEIIT RECORD INSTR NO DATE c:) WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYW LL MANHOLE @ $5 00 0 ALTER REPAIR OR ABAN HWY OR ST WIDENING V SEWER OR DISPOSAL STEM f3 00 STATE ENCROACHMENT PERMIT NO C7 INDUSTRIAL ? WASTE APPROVAL _ OWNERS PERMIT S 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENTIFEE TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL _ ADDRESS BUILDING OR WORK SEPTIC TANKSEEP,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 PLUMBING AND SEWERS ' CESSPOOL ❑ DRYWELL ❑ IHEREBY CE Y THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS R OU IRED BY LOS ANGLES OU NTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR 7HAT I AM THE LEGAL ER AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE OV SCRIBED RE TI ROp PE RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS C3OF PER MTTTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATI JACK R. ALLEN CK M O SUPERVISING MECHANICAL ENGINEER CASH LAf n 9 6 5 51 MAY 8 1 0 D 5.0 0, A APPLICATIONS FOR PERMIT f 76A 6642D,2-EB - 7E COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W JENKINS. SUPT OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FML IN ROs. 9T LGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT j ADDRESS qO( NO OFBLOOS SIZE OF LOT pF O NOW ON LOT CITY TELEAPPR.36dES.ED USE OF DISTRICT NO GROUP M BUILDINGS BK PG CONTRACTOR Sog / G ADDRESS CONNECTION DATA CITY TEL NO STATION 15! .C5 DEPTH ... STATE LIC LICENSE NO CLASS MANHOLE REFERENCE LOWER / NO DeSCRIPTION OF WORK FEE TYPE OF CONNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB PL M L ,TOP L PUBLIC SEWER @ $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO I PITS AND/OR DRAINFIELD ® f 10 o0 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 d CONNECT ADDITIONAL BLDG OR AFFIDAVIT I wAIY[R [AS[M[XT RECORD INSTR NODATE (� WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE C:) f5 00 HWY OR ST WIDENING ~ ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT Lki EL PERMIT NO C/3 INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s z 00 CHARGES AUTHORIZATION TOTAL FEE E (=C-11 CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO-- NNEC7 THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLI EWER APPROVALS DATE INSPECTOR 6 SIGNATURE SIGNED THIS DA 0 Af 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS EOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA R THAT I AM THE LEGAL 1W HER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, T O DESCR ED DENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMr TE BACKFILLSEPTIC TANKS El SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION JACK R. ALLEN CK M o CASH SUPERVISING MECHANICAL ENGINEER �, l s-i ac 5019 1 0 D_ 5.00 DEPARTMENT OF COUNTY ENGINIM Ii I SEWER-SEWAGE DISPOSAL®9 9 DI,VISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES .+ WILLIAM J. FOX, COUNTY ENE31NEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY ADDRESS/D �f ��'2/f�/,� s BUILDINGCROSS ST. r LOCALITY �® DISTRICT NO SERIAL NO. PERMIT NO. c NEAREST � A /g O $- S O CROSS ST. (�J ECEIVED BY Ready for Inspection DATE ISSUED OWNER la��u r.2-16A-A 15— ��I LGt A,L.F�/� �� MAIL' ADORE USE ZONE OCCUPANCY BK MAP PG SS _ _ ' CITY TEL.NO. ' CONTRACTOR (gal if orn i a ';PWPT rnTl t- rio CO.IMP.NO. ADDRESS 1 3] 7 Colegrnyp Avg- JOB.NO. CITY Montebello TEL.NOI1Nion I- ASR TRUNK PERMIT NO. `1 STATE REGISTRATION NO. 10444$ QiJNTY ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. v BLOCK TRACT �Sg INDUSTRIAL WASTE APPROVAL SIZE OF LOTS- X y2 U 10-OF NOW ON LOTS CHARGES .+ USE OF j BUILDINGS CONNECTION RHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT HOUSE SEWER CONNECTING TO7� PUBLICSEWER @ $ 350 D RECEIPT NO. J DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG.OR EXCEPTION RFC ED WORK TO HOUSE SEWER 1.00 NO. I DATE BY ALTER OR REPAIR EXISTING 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 2.00 kANHOLE REFERENCE Sg `OZ t W.. •� LOWER TYPE OF CONNECTIOO LENGTH FROM / OWNERS PERMIT ; I I 00 � Cates- M.L.TO P.L` J AUTHORIZATION I TOTAL FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER ,� A SIGNED THIS-.,3.0 TN.DAY OF -/re�1.. 19,?_3 NEW HOUSE SEWER ��k- OWNER OR ' • CONNECT ADDITIONAL OWNERS AGE BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS..... .... _....Y...---._ --------- _ ��.1 AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP - 'CESSPOOL I] DRYWELL CA TIONAND 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 DISPOSALSYSTEM I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND _ AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS - SEEP.PIT(S)[j CESSPOOLS m- D G -'a SIGNATURE //yy OF PERMITTEE -� - lam..-- - - ............. 7liA642D G63 1/53