HomeMy Public PortalAbout10559 DAINES DR_Sewer__ OErAliTmENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 'I
DIVISION OF-BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES _
' WILLIAM J: FOX, CDUNTY ENGINEER ADDRESS
I BUILDING
/FORK APP/LIICANT/T'O FILL IN / LOCALITYBUILDING
NEAREST
ADDRESS /OV -1'/ -I AiI ..0/J CROSSST. V v v
LOCALITY � ' DISTRICT NO. SERIAL NO. /GPEER,MIITT NO. C
NEAREST �L r A / Q" b$� `J
CROSS ST. /�
^ �] .RE BY Ready for InrGeetion DAZISSUS�
OWNER //�Sn � 1 I/ blJl 3
M0.! '
ADDL RE S USE TONE OCCUPANCY MAP
V
BK PG
CITY - TELAO. A —
CONTRACTOR California Se WOT• ❑ons e_ CO.IMP. N0.
ADDRESS 1317 ColeKroye Ave JOB NO.
CITY NOnt.ebello TEL.NOIjN'I Ort T_Gnwn '
TRUNK PERMIT NO.
REGISTRATION NO.104445 S". LQU NTY ROAD PERMIT N0.
LEGAL \
DESCRIPTION LOT N0. w< — STATE ENCROACHMENT
p. PERMIT N0.
BLOCK TRACT �S Lj INDUSTRIAL -
(� APPROVAL
SIZE OF L0T$ a—i7 S NOW OX LOTS I CHARGESUSOF
BUE DI NOS CONNEC GCHARGE FEE
NO. DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO r REIMBURSEMENT
PUBLIC SEWER Q $ 3.50 RECEIPT NO. DATE BY
HOUSE
PRVATEEWER DISPOSAL SYSTIEM NG TO 1.00
CONNECT ADDITIONAL BLDG.OR / EXCEPTION RECORDED
WORK TO HOUSE SEWER - 1.00
ALTER OR REPAIR EXISTING NO- DATE �I.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 DRAINFIELO 2.00 STATION DEPTH B
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 // LL�r / MANHOLEREFERENCEEFERENCE ��R
(TYYPE OF CO NECTION^ LENGTH FROM
OWNERS PERMIT $
1 DD V. suNB (PLL M.L.TO P.L. �O
AUTHORIZATION TOTAL FEE ' '-z>
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING 1 APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-----.__.. ..-...D Y OF.........._------ .._. . ....19.,_ .'.NEW HOUSE SEWER c-SE S3
OWNER OR "CONLNDING ORDWORKAL
OWNERS AGENT..... f: ... . . ...._ .. ........ .............
SEPTICTANK.SEEP.PIT(S)
ADDRESS..._ _..._.__._._.._._.._._..........._......._.. ..._.....____... IAND/ORORAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- .CESSPOOL E] 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. I SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND .
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBEDn RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
// ft�^ SEEP.PIT(S)E] CESSPOOLS[h /y-v-
SIGNATURETT EE :_..s......._._..:_.. /1 n J �h : __...... _
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