HomeMy Public PortalAbout10554 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENG}IINEER /& 5-. 5
SEWER�SEWAGE DISPOSALI G s 8 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BG
ADDRESS
LOCALITY
FOR APPLICANT TO FILL IN �a
BUILDING A �/� �)0AA-U J �` NEAREST d (,
ADDRESS !J �1 (✓ (fL& CROSS ST. CJ�a`
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
7 , t
NEAREST L,'✓�Z /' A O
CROSS ST
RECEIVED BY Ready for InspegIon DATE ISSUED
OWNER_ J1C�db/h 1 /
MAILADDRESS 0 /FUSE ZONE OCCUPANCY BK MAP PO
CITY TEL.NO. A /
a I �+w
CONTRACTORCalllrornia Sewer Cons ._(!A1 1 CO.IMP.NO.
ADDRESS 1317 Colegrove Ave. JOB.No.
l
CITY Montebello TEL.N(UNlon Z—lssma TRUNK PERMIT NO.
REGISTRATION NO.104445 S STUNTY
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT N0. 7 p2 ' STATE ENCROACHMENT
9^ / PERMIT NO
BLOCK TRACT "Le I)-1V3, I H-7r t INDUSTRIAL-OF
t WASTE APPROVAL
7�
SIZE OF L0TY��� NOW I
ON LOTS \ CHARGES
USOF
BUE DINGS , CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE _ REIMBURSEMENT FEE
IHOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 350 I RECEIPT NO. I �D'AT�E J BY
T HOUSE SEWER CONNECTING TO `'
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED,,
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NOI DATE I�BY�
SEWER OR DISPOSAL SYSTEM 1 00 `
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 ) CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR STATION ��. (� DEPTH
PITS AND/OR DRAINFIELD 2.00
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 I s s ANHOLEUPPERl
TYPE OF CON ECTIO LENGTH FROM
OWNERS PERMIT $ I 1 00 �— caaRB_ P L M L TO P L. s
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 P)JPLIC SEWER
SIGNED THIS JD-r-'-DAY OF_--- ... _ -_._-____-- NEW HOUSE SEWER ti-12-s?
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTS-- - ---_ ��-. BUILDING ORWORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS G,t ` !-._- AND/OR DRAINFIELD
CAI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL
TION 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 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE Q� 7 ,/�l�.L�f/!/•(.P SEEP PIT(S)E] CESSPOOLS
OF PERMITTEE.�_�
76AG42D 663 1/53