HomeMy Public PortalAbout10549 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY -PERMIT APPLICATION ,
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /
ADDRESS O
FOR APPLICANT TO FILL IN LOCALITY 1�4_0it k 4", (,, rl/(�Cl,' �}
NEAREST
ADDRESS /Q.ST 9 /BUILDING �� �!�//ytfJ_�� CROSS ST. ()�Q r�✓�*e- f S b ^�
LOCALITY � � DISTRICT NO. SERIAL NO. PERMIT— S
NO. C
NEAREST 1 A � "�
CROSS ST Y Q RECEIVED BY Ready for Inspection DATEISSUED
OWNER ��/ ® a 15 3
MAIL
ADDRESS �A�/3"Yl 2 USE ZONE OCCUPANCY MAP
BK PG
CITY TEL NO.
CONTRACTOR Calif-() n�aa C�vpn,._ , _ CO.IMP NO � L�Lf Cr
•
ADDRESS 1317 Col egrAye--A.:v^•
JOB.NO
CITY Montebeno TEL N0 [_� TRUNK PERMIT NO.
REGISTRATION NO 1044411 ,b+a 11 COUNTY ROAD PERMIT NO.
LEGAL ® 1 7 STATE ENCROACHMENT
DESCRIPTION LOT NO. ✓i 1�i� PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL N
SIZE OF LOT NO OF BLDGS.
'j f NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE `s
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO I REIMBURSEMENT FEE
PUBLIC SEWER 4@ $ 350 7 JPO RECEIPT NO. `I '' DATE4,,� IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED�4
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 .
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 I CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION L.Ap=fttio _34X6115-DEPTH I
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 200 /1 �y � 3. 1� M�ANHOLER6F5ERENCE
TYPE OF CONNE 1QN--,. LfENGTH FROM
OWNERS PERMIT $ I I 00 V' CURB- l P L•l M L.TO P L $`
AUTHORIZATION 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 _
SIGNED THIS__ .---_TN__ AY OF-------0 a 8.�LgSA NEW HOUSE SEWER 'Sc Yo c
OWNER OR 1C CONNECT ADDITIONAL
OWNERS AGENT _ _
__._._____i%___ BUILDING OR WORK
- - -
- SEPTIC TANK.SEEP.PIT(S)
ADDRESS _ <�.•�- {-- a__ . _.. __ _._. __ _ NO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- ' CESSPOOL E] DRYWELL C]
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SEEP PIT(S)E] CESSPOOLS
.i•G.ri.0/a/�w.- l/-
SIGNATURE / _'�� - -
OF PERMITTEE_ _�__-._e___ __!______ -
76A642D 663 ,_ 1/53