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Home My Public Portal About10324 DAINES DR_Sewer__ 76AS420 6E808 8.89 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES. - SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /) ADDRESS JOHN'A. LAMBIE, CountyEngineer CASSATT D. GRIFFIN, Sut of Building LOCALITY NEAREST- FOR APPLICANT-iTO y FILL IN CROSS ST. LEGAL �(,,I G� . . OWNERlei - , DESCRIPTION LOT NO. � BLOCK = "RTA` 1 ,°� ;; �, � �'�F' MAI L ADDRESS "NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY - TEL. NO: - USE OF* BUILDINGS IG.r�.`¢+'Z _I✓✓<+ DISTRICT N0. GROUP MAP 17 I PROCESSED BY I BK � PG CONTRACTOR . (� ,�° ADDRESS !- CONNECTION DATA CITY_ TEL.N0 - STATION f DEPTH ATE MANHOLE REFERENCE LIPPEIP REGISTRATION NO. COUNTY - ER NO. DESCRIPTION OF WORK FEE PHOUSE SEWER UBLIC-SEWER TO -SEWER@ $3.00 - .�---• _ TYPE OF CONNECTION . LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB .L./ M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO ac. P.C.N0. PRIVATE DISPOSAL SYSTEM' @ $1.00 CO.IMP. NO. JOB NO. CONNECT ADDITIONAL BLDG.OR@ 81 00 ��2 TRUNK PERMIT N0. ROAD PERMIT NO.. WORK TO HOUSE SEWER ALTER,REPAIR OR ABANDON HOUSE STATE ENCROAC ME y SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00. CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I f® REIMBURSEMENT FEE CON- TRACTOR TO CIONNECT THE A 0 EDATE AT DESCRIBED EXISTINGWITH THE HEREINAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19— NEW HOUSE SEWER —�^-- OWNER OR CONNECT ADDITIONAL OWNERS AGENT ` petit/ ._, BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) . AND/OR DRAINFIELD ' I HEREBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION ' AND STATE-THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS- REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND-SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT HOUSE D CALIFORNIA OR THAT I AM THG LEGAL OWNER OF THE ABOVE ❑ ,y(_� - DESCRIBED RESIDE ''L PROP bYBACKFILL SEPTIC TANKS`. s. --- - ' SEEP.PIT(S) ❑ CESSPOOLS ❑ SIGNATURE - OF PERMITTE �e / • OF ALMATION ROBERT A. WOOD cK. M.o, CASH SUPERVISING MECHANICAL ENGINEER P:d,�akEl P:5 APPLICATION FOR PERMIT SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICT NO. I GROUP BK PG MAP PROCESSED BY BUILDING ADDRESS f ' CONNECTION DATA LOCALITY NEAREST STATION DEPTH CROSS ST. UPPER MANHOLEREFERENCE LOWER OWNER TYPE OF CONNECTION LENGTH FROM MAIL Y. CURB P.L. M.L.TO P.L. ADDRESS P.C.NO. CO.IMP.NO. JOB NO. CITY TEL.NO. - LEGAL TRUNK PERMIT NO. ROAD PERMIT NO. DESCRIPTION LOT NO. AFFIDAVIT I WAIVER I EASEMENT RECORD,INSTR,NO, DATE BLOCK TRACT NO:OF BLDG5. SIZE OF LOT NOW ON LOT HWY,OR ST.WIDENING USE OF BUILDINGS STATE ENCROACHMENT ., PERMIT NO. INDUSTRIAL CONTRACTOR WASTEAPPROVAL ADDRESS CHARGES CONNECTION CHARGE FEE CITY TEL.NO. STATE LIC. REIMBURSEMENT FEE V LICENSE NO. CLASS W NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE HOUSE SEWER CONNECTING TO U. PUBLIC SEWER SEPTIC TANK.SEEPAGE PIT OR NEW HOUSE SEWER ix PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC TANK.SEEP.PITIS) CONNECTADO AND/OR DRAINFIELD a WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL ❑ DRYWELL❑ W E XTN.,CESSPOOL.DRYWELL.MANHOLE �... ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR.SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS LlSEEP.PIT(S)❑ CESSPOOLS._. OWNER'S Permit s AUTHORIZATION TOTAL FEE _.— VALIDATION I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19 OWNER OR OWNERS AGENT ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICEN5 ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RE- SIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE OF PERMITTEE CEBU8IREV 6,78' APPLICATION: FOR PE RMI SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY ' FOR APPLICANT TO FILL IN DISTRICT NO GROUP. MAP. CESSED BY 13K �PG BUILDING f F Dry ��/ �G/ `"1 A �r ADDRESS / L� �e f- �Q CONNECTION DATA LOCALITY , NEAREST STATION• '^ I�' DEPTH ' CROSS ST. UPPER- () �1 � MANHOLE REFERENCE LOWER OWNER V �j C..(�.p )yam)/^ TYPE OF CONNECTION LENGTH FROM ADDRESS �4 C. i/'!es IVB • Y. CURB P+L M L.TO P L MA CITY' (�( TEL NO CO IMP NO.' JOB NO ' 'I LEGAL TRUNK PERMIT NO ROAD PERMIT NO. DESCRIPTION LOT NO. 1• ,R, t AFFIDAVIT WAIVER I EASEMENT, RECORD INSTR NO DATE, BLOCK TRACT N OF SLOGS SIZE OF LOT N ON LOT HWY OR ST WIDENING ' USE OF BUILDINGS STATE ENCROACHME PERM ITNO CONTRACTOR Sha c , INDUSTRIAL S WASTE APPROVAL ADDRESS /032. e r. ,CHARGES CITYje_ TEL.NO �-('T-✓�SO CONNECTION CHARGE FEE STATE / LIC REIMBURSEMENT FEE LICENSE NO 3 CLASS _. ♦.nti••^•••✓•n._. NO DESCRIPTION OFWORK FEEAPPROVALS _. DATE INSPECTOR'S SIGNATURE V HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 NEW HOUSE.SE WER 'SEPTIC TANK„SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD CONNECT AL �f L-`� t/�� `�,t,,:. ), HOUSE SEWER CONNECTING TO BUILDING OR WORK • � 1� N r” � PRIVATE DISPOSAL SYSTEM SEPTIC TANK,SEEP,PIT(S) CONNECT AD AND/OR DRAINFIELD WORK TO HOUSE SEWER '' - OVEI?FLOW SEEPAGE PIT,.DRAINFIELD CESSPOOL [I DRV WELL❑ EXTN.CESSPOOL,DRYWELL.MANHOLE ALTER.REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM 'DISCONNECT PLUG-AND - ^ ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS❑ - •.OWNER'S Permit s �I SEEP,PITIS)❑ CESSPOOLS❑ AUTHORIZATION TOTALFEE' % - 'VALIDATION-- I HAVE AT THIS DATE A CONTRACT-WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER _ SIGNEDTHIS - DAY'OF" '" 19= "-"• '" ' •• OWNER OR - � -@'5 2 3,6 A OWNERS AGENT ADDRESS '# 0 0 0 0 1 0 I HEREBY ACKNOWLEDGE THAT'I'HAVE READ THIS APPLICATION °"' '- -` •� •• AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 2 O'O 1 O O WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING , PLUMBING AND SEWERS n I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR O O O 1 •L V o V i LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF. v V CALIFORNIA ORTHAT I AM THE LEGAL OWNER OF,AND INTENDTO RE- _ SIDE IN,THE ABOVE-DESCRIBED RESIDENTI •PROPERTY {3 !T SIGNATURE O 2—'79 U /. -! 7 - OF PERMITTEE '