HomeMy Public PortalAbout10545 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL-1-9231
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
6 COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER �I ADDRESS .�QJ✓rb � �V /
b FOR APPLICANT T F14 IN LOCALITY BUILDING NEAREST � o ^�' t �--CD
ADDRESS CROSSST ��(!'�
LOCALITY DISTRICT NO SERIAL NO. PERMIT NO. r-
NEAREST A /� d � o S
CROSS ST
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER 1. •6
MAIL
ADDRESS USE ZONE I OCCUPANCY I BK MAP PG
/ /
CITY TEL.NO. A — r
CONTRACTOR California Sewer ConSt.Co. CO.IMP.NO.
ADDRESS 1317 Colegrove Ave. JOB.NO.
CITY • Montebello TEL.NO.UNlon 1-5048 TRUNK PERMIT NO.
REGISTRATION NO 104445 Sq4%, TEY ROAD PERMIT NO
LEGAL ems. / STATE ENCROACHMENT
DESCRIPTION LOT NO // (/ /{ PERMIT NO
BLOCK Cti ITRACT INDUSTRIALWASTE APPROVALNO
SIZE OF LOT X� NOW ON LOTS. CHARGES
USE OF S
CONNECTION CHARGE•F,EE
BUILDING
NO. DESCRIPTION OF WORK FEE ~�/
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 D RECEIPT NO. /I� DATE 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 / NO DATE BY
SEWER OR DISPOSAL SYSTEM 1 00 J �_,
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION �I�a( � DEPTH Q
CESSPOOLO DRYWELL / MANHOLE EFERENCE `� '
SPECIAL CONDITIONS ONLY 200 YV
LOWER
TYPE OF CONNECTION LENGTH FROM' �
OWNERS PERMIT ¢ I I 00 CtMB ( P2 M L TO P L
AUTHORIZATION I TOTAL FEE
1 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
TN '
SIGNED THlS--3o___... AY OF._. 0.C2o B_,E/z...1953 NEW HOUSE SEWER
OWNER OR
\ CONNECT ADDITIONAL BUILDING OR WORK
OWNERS ADEN __._____ _
SEPTIC TANK,SEEP.PIT(S)
ADDRESS- -------..._--•-•.--•.---------..._---•---.-..-....__-..-._....---......-. AND/OR DRAINFIELD
1 HEREBY ACKN6WLEOGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E]
CA
TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL'COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBIN ND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 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 BEDESIDENTIAL PROPER BACKFILL SEPTIC TANKS
SIGNATURE - SEEP PIT(S)[] CESSPOOLS 2
OF PERMITTEE
S6A642A 663 7/53 ,