HomeMy Public PortalAbout10306 DAINES DR_Sewer__ DEPART 4F,NT OF COUNTY ENGINEERI SEWER—SEWAGE ®ISPOSAB.
DIVISION OF BUILDING AND SAFETY
PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENC31NEER I BUILDING
ADDRESS
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FOR APPLICANT TO FILL IN 1 LOCALITYBIPLDING NEAREST
,
ADDRESS O S40 04 / A.) ( I CRO S ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST r�AG��Jd� 4—
CROSS ST. L7
/� /7 RECEIVE Yf Ready for Inspection D7-�
SSSUED
OWNER &, AA b� A ( �/��L ��� ��� 2/`-+
MAIL USE `-
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ADDRESS BK PG
CITY �rTEL.NO. �/ ��� IAJ 192
CONTRACTOR l �//d-� G ?+'{, CO.IMP. N0. /
ADDRESS S 3 / -JOB NO. /
CITY tl 41 Qr �. TEL.NO. CIS TRUNK PERMIT N0.
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e STATE
REGISTRATION NO. `7F �[ t COUNTY ROAD PERMIT N0.
LEGAL DESCRIPTION LOT N0. 1r J G�J� /Q�/ STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT b INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTS 2S�J NOW ON LOTS CHARGES /
USE OF c /
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 3.50 RECEIPT NO. I ®TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR CEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO,
I DATE, I 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 OiSDEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 2 SAN PP FERENCE
t+OYY-ER
TYPE OF C-Q.NNECTILENGTH FROM
OWNERS PERMIT ; 1 00 ' CCisI�9� P.L' M L.TO P.L.
AUTHORIZATION TOTAL FEE S
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 !t/
SIGNED THIS__- ._-_-..DAY OF...... -t 19S NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-I.. ____. __: __ __ •-_•._-_ _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS... ._.zr..Z.. .. �._...... .. ._._..____._..._ _._ AND/OR DRAINFIELD _
I HEREBY ACKNOW EDG THATVI HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION AND STATE T AT E ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL NTY 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 A THE LEGAL WN-
ER OF THE ABO ESCRIBED N A PROPER ! BACKFILL SEPTIC TANKS
SEEP.PIT(S)C] CESSPOOLS El
SIGNATURE
OF PERMITT - - - - - - ....•.... ......------.
76A642A 663 7/53
DEPARTDiENT OF COUNTY ENGINEER ! SEWER—SEWUAGE DISPOSAL—
' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELI{:S (,
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /� g� / G1 +
ADDRESS (G
t_—FOR APPLICANT TO FILL IN/,
LOCALITY _7
r BUILDING a� �`� /' // -�� NEAREST
ADDRESS ��y���� �.r�nst,-1,!.�-:� X�Istst�,sT� CROSS ST.
LOCALITY /� (� %? � p� n DISTRICT NO. .- Ready for Inspection PERMIT NO.
NEAREST
I �7gAlf s
CROSS ST. -
RECEIVED BY DATE I UED BY DATE
OWNERMAIL
9f� �
r
ADDRESS _ d �� i USE ZONE v OCCU�PANCY� � IV=EMAP
CITY �,�t.✓ � •,✓y�iTEL.NO. OOD
CONTRACTOR (/ ~M. C. Nottingham Co. of So. Cal. CO.IMP.NO.
v l -
ADDRESS 5933 N. CLOVERLY AVE. JOB.NO.
CITY TPpg CITY, CALIF.
TRUNK PERMIT NO.
TATE
REGISTRATION NO._- /twa +� COUNTY ROAD PERMIT NO.
LEGAL 3 S STATE ENCROACHMENT
DESCRIPTION LOT NO., S ' PERMIT NO.
BLOCKTRACTh� INDUSTRIAL
l
SIZE OF LOT_ 41 NOW ON LOT NO.
WASTE APPROVAL/ CHARGES
USE OF o
BUILDINGS CONNECTION CHARGE FEE
NO. DESCR.IPTI N OF WORK FEE I
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 i 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE I BY
_ SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR f
.PITS AND/OR DRAINFIELD 2.00 STATION T/L �lCor DEPTH n
CESSPOOL—DRVWELL
SPECIAL CONDITIONS ONLY 2.00 /O (/f 'G /M NUPPER EFERENCE
i TYPE OF CONNECTIONLENGTH FROM
L
OWNERS PERMIT $ I � ' Y. CURB P. M.L.TO P.L.
AUTHORIZATION TOTAL FEE 4
I 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
SIGNED THIS DAY OF 191�,i' NEW HOUSE SEWER
OWNER OR �� /� ( CONNECT ADDITIONAL '
OWNERS AGENT � �-�'�r' �?!�' 'BUILDING OR WORK
- 'SEPTIC TANK.SEEP.PIT(S)
ADD RESS..._.._.....-__..-.._.--.._......- -.-.--- ._---.._.._-•-.--•.-_---- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI•{ CESSPOOL[:3DRYWELL
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 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY, DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ' ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBE DEN AL PROP RTl BACKFILL SEPTIC TANKS��
SIGNATURE
P SEEP.PIT(8)� CESSPOOLS
OF PERMITTEE. _ o
76A642D S&E 663 4/54