HomeMy Public PortalAbout10502 DAINES DR_Sewer__ r DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
�1 COUNTY OF LOS ANGELES
,WILLIAM J. FOX, COUNTY ENGINEER i BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING cc�� ////� /� NEAREST
CROSS ST
ADDRESS ,//) ��c./ T'//3 i wet Q.(� /�sVV�-Y.
LOCALITY �IP.A-ArA _4 YD �A� DISTRICT N0. VSERIAL N0. PERMIT NO. C
NEAREST i — A / �/ S
CROSS ST (/
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER }3"YVti3VN �1 V sll(L�'!/l CSI, l p J
MAIL USE ZONE OCCUPANCY MAP
ADDRESS ld/f/Lt . I I BK PG
CITY TELAO. A -1
CONTRACTOR California Sewer Const.en_ CO.IMP.N0.
ADDRESS 1317 Colegrove Ave. ADB.NO. �—
CITY' Montebello TEL.NO.UNlOn 1$0-548 TRUNK PERMIT NO.
TE
REGISTRATION NO 104445 S&�aaIANTY
LEGALys� �`�,"� ��,,�� �y ROAD PERMIT NO
DESCRIPTION LOT NO.1A,)Un 974 I r STATE ENCROACHMENT
PERMIT NO
BLOCK),j,j?.fN.LgRACT =! � L LJ,�tf •r' 7 —�� INDUSTRIAL
11 1 WASTE APPROVAL ��—
SIZE OF LOT9749 K NO OF OW ON LOTUSE OF
S 1 CHARGES
BUI DINGS �Qf/jCl CONNECTION CHARGE FEE _
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
I PUBLIC SEWER @ $ 3 50 RECEIPT NO. I /DA`TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR _,,EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO
DATE 'I�B\
ALTER OR REPAIR EXISTING I
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 114- 71, O DEPTH t�
CESSPOOL—DRYWELL /
SPECIAL CONDITIONS ONLY 200 ?i 1 /Sd MANHOLE REFERENCE
UPPER
LOWER
TYPE OF CONNECTION LENGTH FROM /
Y-.— CURS � LP L. M L TOP L
OWNERS PERMIT $ 1 I 00,-
AUTHORIZATION TOTAL FEE D jY v
IHAVE CONTRACTORS DATE TO CONNECT THE ABOACTED IVE DESCRIBED IEXISTING AED PPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE �P413LIC SEWER
4!qt ,p
SIGNED THIS --QDAY OF _v . _._19 .3 NEW HOUSE SEWER
/ �" CONNECT ADDITIONAL
OWNER OROWNERS AGEN�Q��?__t. ,__� j �_ BUILDING OR WORK
V �' G/ SEPTIC TANK,SEEP.PIT(S)
ADDRESS ______ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
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 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS R `
SIGNATUREf J J� n SEEP PIT(S)C] CESSPOOLS E]
OF PERM ITTEEL_�(-)
76AG42D 663 1/53 I,I