HomeMy Public PortalAbout10606 DAINES DR_Sewer__ DEFATLTMENT OF COUNTY EINGTNEER SEWER-SEWAGE DISPOSAL 1,
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ADDRD NO
ESS
/� bPLICA O FI IN p( �r LOCALITY
BUILDING_, r �C..t��/ NEAREST L�
A DO REBS �y/- l� ,tel CROSSST.
LOCALITY / / DI TRICT NO. SERIAL N0. PERMIT N0.
NEAREST W A /,U Ay S
CROSS ST.
OWNER
RECE� BY ReAOY for Inspection DATE ISSUED _
� /IVED� C] `I /. /♦ 3
MAIL USEZONE OCCUPANCY 7S MAP PG V
ADDRESS 1/\ OK PG
CITY TEL.NO. V///jNVf Y✓/Vl
CONTRACTOR
sz CO.IMP.N0.
ADDRESS JOB NO. '
CITU EL.NO.�JTRUNK PERMIT N0,
TE
REGISTRATION NO. /�j _J C / COUNTY ROAD PERMIT NO.
LEGL
DESCRIPTION _ LOT NO. ��,h(J' �'� .�.C7/lI STATE ENCROACHMENT
ry/" /l JJ� � � � � PERMIT NO.
BLOCK TRACT I� )xLC�C(�T,�,ww0 WASTE APIAL
PROVAL
SIZE OF LCT �Q �/ (� J NOW ON LOTS I CHARGES
USE OF �//��\
BUILDINGS �lPy CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER ® S 3.50 Jv RECEIPT NO. I DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER LOD
ALTER OR REPAIR EXISTING NO, I DATE IBY
SEWER 09-DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 1 V DEPTH
CESSPOOL—DRYWELL
SP ECIAL CONDITIONS ONLY 2.00 � � MANS EFERE%Ea- , LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT S 1 DO r CURBS P.L. M.L.TO P.L. L
AUTHORIZATION . TOTAL FEE ((� (3-V
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR 4THE
NNECT THE A OVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO PUBLIC SEWE
SIGNED THIS. .DAY OF. _ _..._I NEW HOUSE SEWER ('
OWNER OR CONNECT ADDITIONAL
OWNERS E ..... BUILDING OR WORK
......_...... ..._.._....__.._.. . ..._......._. SEPTIC TANK.SEEP.PIT(S)
ADD .... .. ..... ... .. AND/OR DRAINi1ELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO C0 fl
PLY 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 CALIFOR IA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DE IBED REST TIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)C] CESSPOOLS[:3.. .....
OF PERMITTE .......... _. -------- ................ ......
76AB42D 663 1/53