HomeMy Public PortalAbout10406 DAINES DR_Sewer__ I
DEPARTIIIENT OF COU'N'TY ENGINEER SEWER..;-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY , PERMIT APPLICATION
I� COU-3= OF LOS ANGELES .
WILLIAM J. FOX, COUNTY ENGINEERJ BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY ��
BUILDING - '-77 NEAREST O
ADDRESS Zo0(� �AJN-,� ,yi(? CROSS ST.
LOCALITY r, e - DISTRICT NO SERIAL NO. PERMIT NO. '
NEAREST A ' Al-I :�l / S
CROSS ST. nw le A.4 -
C�EIVED BY• Ready for Inspection DATEISSUED
OWNER �FA4 Z 2, TMAIL
ADDRESS �Q�p �. r p/9�/I/ ,Sr USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO. Q 4 �Qle I
v
CONTRACTOR 114 A,4 [gllMe,6e, CO.IMP.NO. LAG
ADDRESS U Z, 44,4, 4 a JOB.N0.
CITY /,moo S.Cl�f AD TEL.NO./)-r-2 TRUNK PE1tM1T NO. /
STATE
REGISTRATION N0. ®Q ROAD PERMITTNO.
LEGAL 4: ./ 7STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NOIf
\
BLOCK TRACT A,cyJ�/��r/ /7�0, � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 5 N0.OF BLDGS. CHAR ES
NOW ON LOT
USE OF r
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIIPTION OF WORK FEE REIMBURSEMENT FEE N-1,
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 E 3.50 O RECEIPT NO. DATE\ I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR _ EXCEPTION RECORDED
WORK TO HOUSE SEWER 1:00 N0.
ALTER OR REPAIR EXISTING I DATE BY`
SEWER OR DISPOSAL SYSTEM 1.00 \`
DISCONNECT AND ABANDON SEWER N
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION t1,02 d DEPTH 5
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENC
U�QEA�'
16 LOWER
TYPE OF CONNECTIO LENGTH FROM v
Y. CURB (,P.L. M. L.TO P L.
OWNERS PERMIT ; I 1 00
AUTHORIZATION TOTAL FEE o
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__�!N�__�._ _19 NEW HOUSE SEWER
OWNER OR � . D __ CONNECT ADDITIONAL
OWNERS AGENT.._.�f7' !tf.-_. BUILDING OR WORK /
�._..
// SEPTIC TANK,SEEP.PIT(S)
ADDRESS_L-0_�_B.......66..A4 ._ ...A .. L-.�.� 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 - I
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED A REQUIRED BY LOS ANGELES COUNTYJ ABANDON HOUSE SEWER
AND STATE OF CALI NIA OR TIIIiii T I TILE LEGAL OW
ER OF THE ABOVE CRIBED 1D L P 0 ERTY. B L SEPTIC TANKS I ai�w/�,✓t/V�I/ �r T x
P.PIT(S) CESSPOOLS
- d
SIGNATURE
OF PERMITT - ------- - - -------------•--- ...
76A642A 663 7/53v"7 7T 777r`
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