HomeMy Public PortalAbout10611 DAINES DR_Sewer__ r
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TsasazD APPLICATION FOR PER T `fI II
II
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPO L u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADp.Ess 10611 Daines Dr.
WILLIAM A. JENSEN, Sup't of Building
LOCALITY Temple Cit
END.
FOR APPLI ANT TO FILi
PO55LEGAL
DESCRIPTION LOT NO PWNE"AJBLOCK TRACT FCILOF"S Same
°F SLOG
SIZE OF LOT NOW ON LOT CITY T.I. NO.
USE OF
BUILDINGS ResO DISTRICT NO. GROUP MAP /7gOCES 0 B
CONTRACTOR Square Deal .Sewer Ser vic
0 .K PSG V
ADDRESS2933 Maxson Rd. CONN�(ECCTION DATA
CITY
El Monte TEL. NO. GI -2020 STATION O . ` DEPT" /
�{(��f V
1200 (0 ❑ ST ry Y MANHOLE REFERENCE �J UPPER
REGISTRATION NO 7
NO. DESCRIPTION OF WORK FEE ` TYPE OF CON NECTIO NGTH FROM r �.
HOUSE SEWER CONNECTING TO Y. CURB P.L.' .L.TO P.L. O
PUBLIC SEWER @ $5.00
SEPTIC TANK.SEEPAGE PIT OR P.C.NO; V
PITS ANO/OR GRAINFIELD SUOGO 111 CO.IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PER IT NO, ROAD PERMIT NO. O
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG,ON I I pFFIOAVIT SUNUN RECOR°. I"ST O. I DATE
WORK TO HOUSE SEWER S3OO
OVERFLOW SEEPAGE PIT,DRA1NFIEL° y
EXTN.,CESSPOOL,ORYW EL L,MANHOLE@ $5.00 y
ALTER.REPAIR OR ABANDON HOUSE MWY. OR ST.W I.ENING L
SEWER CR DISPOSAL SYSTEM 53,00 STATE ENCROACH ME
PERMIT NO.
INDUSTRIA
• WASTE gOVAL
CHARGES
OWNERS PERMIT S z o0
AUTHORIZATION I TOTAL FEE 7
0 ONN ECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURBEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E ISTIN6 DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGN T RE
SIGNED THIS DA OF 19
OWNEROR (� NEW HOUSE SEWER
OWNERS AGENT
ADDRESS CONNECT ADDITIONAL
BUILDING OR WORK
in/
SEPTIC TANK,SEEP, PITIS)
HEREBY ACKNOWLEDGE THAT 1 HAVE RENO THIS APPLICATION pryD/°R pRAINFIELD
IT STATE THAT THE ABOVE Is CAN0 AND AGREE COMPLY
WITH ALL COUNTY
ORDINANCES ANO STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ GRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF ANO INTEND TO D15CONNECT PLUG AND
RESIDE IN, THE ABOVE ESCpIBED RESIDENTIAL fl0 OPTY. ABANDON HOUSE SEWER
SIGNATURE J
OF PERMITTEE BACKFILL SEPTIC TANK$ ❑
SEEP.PIT I51 ❑ CESSPOOL Q YlL ✓J
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.D. CASH
LALo 5 6 2 4' OGT 17 1 0 ,D 7.0 0-