HomeMy Public PortalAbout10539 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY i PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY ,
BUILDING -? /? /1 I )Q A", n NEAREST
ADDRESB _T "9 j'� / ,/ CROSS ST.
LOCALITY OAAA n-lep -n�Z'7 DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST ^/ Y A /et��/ S
CROSS ST �'` Y RECEIVED BY Ready for Inspeotion DATE ISSUED
OWNER
MAIL ^� � USE ZONE OCCUPANCY MAP
ADDRESS �C/ BK' PG
CITY c TEL.NO. A - ! /&.,:,
CONTRACTOR California SP-WAr rnngt - 0moo CO.IMP.NO.
ADDRESS 1317 C.olegroye AVA_ JOB.NO.
CITY Montebello TEL.NO. jjNl on 1-0i048 TRUNK PERMIT NO. a
STATE'
REGISTRATION NO 104445 SYPVTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NOI,
e LJJ (O LO �S NBA /J / -1 7- /p STATE ENCROACHMENT
PERMIT NO
BLOCK t� Z TRACT $S `� INDUSTRIAL
APPROVAL
SIZE OF LOT 76x /�a N0.OF BLDGB. 1
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT`EE
HOUSE SEWER CONNECTING TO I\
PUBLICSEWER @ $ 350 � RECEIPT NO. � DATE BY
HOUSE SEWER CONNECTING TO `
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTIONIRECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO I� 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 DRAIN1_FIELD 2.00 STATION TIL 9/, DEPTH - 9
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
L"ER JZ LOWER
TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT $ 1 00 e M L TO P L
6 P L
AUTHORIZATION I TOTAL FEE
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_�10 DAY OF..--4J-�!�!�l�e IG.....1953 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT- , _ _ BUILDING OR WORK i
ADDRESS �J- - SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/CR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE / SEEP.PIT(S)Ej CESSPOOLS
OF PERMITTEE-- - ii
I\642Df 603 1/53 �a