HomeMy Public PortalAbout10532 DAINES DR_Sewer__ DEPARTkIENT OF COUNTY_ENG19C=- SEWER—SEWAGE DISPOSAL 291
DIVISION OF BUILDING AND SAFETY PERMfT APPLICATICJI�i "�
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ;I BUILDING /0 S'3ry] L g_4 � 42v
ADDRESS
FOR APPLICANT/ O FILL IN LOCALITYBUILDING
NEAREST
AQDRESS �`� p� ! CROSS ST
LOCALITY DISTRICT N0. RIAL NO. PERMIT NO.
NEAREST '
S /g a S
CROSS ST I VED Y Ready for Inspection DATE ISSUED
OWNER
Cb
jfL 1,4_ S�
MAIL
ADDRESS /USE ZONE I OCCUPANCY I BK MAP PG
/.1
CITY TEL.NO. m )
CONTRACTOR California Sewer oanat Co- CO.IMP.NO.
ADDRESS 1317 Colegrove AVE?. JOB.N0. �
CITY Montebello TEL.NGUNlOn I-.rQ48 TRUNK PERMIT NO.
�] STATE
REGISTRATION NO 1044455 —�_
S Lk]nUNTY ROAD PERMIT NO.
LEGL
DESCRIPTION LOT NO /44•LIJP.e(�{_/p2, STATE ENCROACHMENT
. IF �J PERMIT NO ^
BLOCK TRACT q'Q/ /�� / ��I INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 7,1 n N
OF BLDGS. )
NOW ON LOT I CHARGES
USE OF n A
BUILDINGS ^\' 1�. CONNECTION�CHARGE FEE y
NO DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE`
PUBLIC SEWER 0 $ 3 50 RECEIPT N0. DAT I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO / DATE \ BY
ALTER OR REPAIR EXISTING _
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 "�9t0 DEPTH
CESSPOOL—DRYWELL /
SPECIAL CONDITIONS ONLY 200 / / MANHOLE REFERENCE t v LOWER
TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT ; I pp P L M L TO P L Z 5
AUTHORIZATION I TOTAL FEE /V,
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 F- t2fC2�4d/..... 19.E NEW HOUSE SEWER
OWNER OR Q� CONNECT ADDITIONAL
OWNERS A ENT-_QC!�T_ BUILDING OR WORK _
7 ALJSEPTIC TANK,SEEP.PIT(S)
ADDRESS Q- -vJ- --- `- _-_ -- _ .. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI-. CESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO GOP.IPLY 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 DESCR ED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE /y SEEP PIT(S)[:] CESSPOOLS I]
-
OF PERMITTEE_ �
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