HomeMy Public PortalAbout10526 DAINES DR_Sewer__ 5aE`e 911.55 APPLICATION FOR PERMIT 1
DIVISION OF�BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING
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JOHN A LAMBIE, COUNTY ENGINEER
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY ,��,. •� `
FOR APPL:I�CANT TO FILL IN
NEAREST ♦ c3'
LEGAL "> Q / '/K�
DESCRIPTION LOT NO OWNER
MAIL /. t
BLOCK TRACT
/ � �f �6 moi. ADDRESSNO OF _ ,�l�'�-�,
SIZE OF LOT 7 -t A J 7 NOW ON LOTS CITY TEL. NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP
BK PG
CONTRACTOR M(
ADDRESS
` 2 I'Q CONNECTION DATA
�/ /
CITY 5 TEL NO STATION DEPTH
MANHOLE REZ EN.CE_ UPPER
El STATE 3' LOWER
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION —� LENGTH FROM- _
PUBLIC SEWER @ $ 3 50 Y. CURB P L M L TO P L
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD @ $ 3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD - P C NO _
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $ 2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NOAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $ 1 00 d PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE '
OWNER'S , PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE "
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER '
SIGNED THIS OF 79CONNECT ADDITIONAL S�p �
OWNER OR BUILDING OR WORK ddJJ
OWNERS AGENT SEPTIC TANK SEEP, PIT(S)
'ADDRESS - AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR,
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
II HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I ANI THE LEGAL OW ER OF THE ABOVE
DESCRIBED ESIDENTIAL PROP T BACKFILL SEPTIC TANKS❑
SIG T E SEEP PIT(S) ❑ CESSPOOLS❑
OF
JOHN A LAMBYE, COUNTY ENGINEER VIE LIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK H O CASH
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DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION_QF_3ITILDING AND SAFETY � PERMIT APPLICATION
OF LOS ANGELES � BUILDING _
WILLIAM J. FOX, COUNTY ENCdINEER I ADDRESS )��,
FOR APPLIC TO FILL IN LOCALITYBUILDING
/�Q,s2.� QI.Otpe f I NEAREST
ADDRESS
�� CROSS ST.
LOCALITY DISTRICT NO SERIAL NO. PERMIT NO.
NEAREST�"�
CROSS STI
/ RECEIVED BY Ready for Inspection DATE ISSUED
OWNER /C�lO/C/J / /CS ( Gi'=�•1•—�- L��S�S�
MAIL /e?.s
ADDRESS /�/fjC� � USE ZONE OCCUPANCY MAP
_ // � � 1 �j �` BI( PG
CITY /��7S19/G Ci,, �/ TE L.NO. A— 1 \�c.7 V4�: 4-
CON
-
CONTRACTOR�6l •✓/�.9 CO.IMP NO
ADDRESS �° B NO.
CITY ��vi� TEL N0. TRU PERMIT NO /
TATE
REGISTRATION NO. O O jam!! COUNTY ROAD PE IT NO
LEGALry STATEENCR CHMENT
DESCRIPTION LOT NO. �� /A / PERMIT NO
BLOCK TRACT �� INDUSTRIAL
WASTE APPROVAL
SIZE OFLOT ,;:? �(a NOW ON LOTS �CH'AAGES
USE OF !
BUILDINGS Q �y�� CONNECTION CHARGE F
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO N REIMBURSEMENTFW \
PUBLICSEWER Q $ 350 ✓ p RECEIPT N . I DATE \I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDO.ORp0 / 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 I
PITS AND/OR DRAINFIELD 2.00 STATION � 27, S DEPTH CA;�
CESSPOOL—DRYWELL
—8 ECIAL CONDITIONS ONLY 2.00 MANN EFERENCE
TYPE OF CONNECION ✓LENGTH FROM
OWNERS PERMIT 00
/
Y CURB PL. ML TOPL
� I
AUTHORIZATION I TOTAL FEE ,so
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...--____D OF.- !I-GG_Y� _.1 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----- BUILDING OR WORK
ADDRESS____l pS.2 _�/_ � �_ r- SEPTIC TANK,SEEP.PIT(S)
-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL I] DRYWELL E]
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
/7 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
1 AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
y AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
-'- SEEP PITS)[:) CESSPOOLS
SIGNATURE
OF PERMITTEE.._e,._aY�9��
76A642A 663 7/53 c .�pe� D,