HomeMy Public PortalAbout10424 DAINES DR_Sewer__ k)EPAR,TIIZENT OF COUNTY ENGEgEEP. SEWER—SEWAGE DISPOSAL 1093
t DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT T FILL IN LOCALITY Cc
BUILDING1Lnf NEAREST
ADDRESS rG1 �}/� CROSS ST /
LOCALITY DISTRICT NO. ,SERIAL NO. PERMIT
{ S
NO. c
NEAREST A I? 0 74 S
CROSS ST
/ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER r/ CA -J3
MAILUSE ZONE��� � OCCUPANCY MAP
ADDRESS BK PG I ^
CITY TELAO. 1
CONTRACTOR California Sewer (�nriSt GAS CO.IMP.NO. /)4-1 r
ADDRESS 1317 Colegroye Ave. JOB.NO.
CITY Montebello TEL NO.UN1 do 1-50418 TRUNK PERMIT NO.
I❑y-.I� STATE
REGISTRATION NO 104445 S£6 NTY ROAD PERMIT NO.
LEGAL ' n^ STATE ENCROACHMENT
DESCRIPTION LOT N0. 4 PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT X a NNO OF OW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTIO.NCHARGE FEE /
NO DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO \ REIMBURSEMENT FEE
J PUBLICSEWER @ $ 350 % 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
ALTER OR REPAIR EXISTING NOI DATE "*%� 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 D_RAINFIELD 2.00 STATION /a.r 47, r DEPTH
CESSPOOLDRYWELL S2 !� L ANUPPER EFERENCE
_SPECIAL CONDITIONS ONLY 200 J
YPE OF CONNECT]
LENGTH FROM L
OWNERS PERMIT $ I 00 CURB_ M L TO P L. J
AUTHORIZATION I TOTAL FEE
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P ELIC SEWER tt��
_ NEW HOUSE SEWER K II-
SIGNED THIS-3o.l-_ AIF O -. .. ......... -._ .- 19 -3 �C O
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN BUILDING OR WORK
- -
,��//�� SEPTIC TANK,SEEP.PIT(S)
ADDRESS - - -- , � "(.iJGi AND/ORDRAINFIELD
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL I]
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
1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/CR 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 qg
-
SIGNATURE SEEP.PIT(S)(�_CESSPOOLS lam•/�
lT'_ �
OF PERMITTEE----`--)r ---•-----.............� - ' �
�t 76A642D 663 1/53 ., _