HomeMy Public PortalAbout10615 DAINES DR_Sewer__ 76A64zD 1B=B3f APPLICATION F /R PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT- OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION aUILDING
JOHN A. LAMBIE, Count En ADDRESS Q ( S
County ginger
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLICANT' TO `ROSS ST.
LEGAL
DESCRIPTION LOT NO- //� OWNER
MAIL -V
BLOCK TRACT ADDRESS
NO. OF BLOCS.
SIZE OF LOT NOW ON LOT CITY TEL, NO,
O
USE F MA
- -
USE -NGS DISTRICT NO. GROUP 'PP PR OOCEEESSED BY
BK PC
CONTRACTOR
ADDRESS 4 / CONNECTION DATA
C/ STA O 1
N A� . L DEPTH
CITY . NO. /
UPPER
Iy-/I, STATE MANHOLE DEFERENCE
REGIS//TRATION NO. a� LJ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. 7'
PUBLIC SEWER @ $5.00 QL
SEPTIC TANK.SEEPAGE PIT OR I - �.Z F P.C.NO. O
PITS E E-E GRAINFIELD CONNECTING
SIO.00 CO,IMP.ER C.I JOB PER V
HOUBE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT /1/ C
PRIVATE DISPOSAL SYSTEM 43.00 (%
CONNECT ADDITIONAL L.G.BOR 'AFFIDAVIT .11Y 5[N[ RECORD.INSTR.NO. DATE r
WORK TO HOUSE SEWER ® 43.00 V
OVERFLOW SEEPAGE PIT,ORAINF(ELD W
EXTN.,CESSPOOL.ORYWELL,Ma `,06E 45.00
ALTER,REPAIRORABANL.
SEWER ORO AL SY EM / ® 53.00 STATE EN OA NT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWCHARGESNER'S PERMIT s �z,>eo
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY JJF 19_OWNER OR /'w NEW HOUSE SEWER
OWNERS AGENT /SNy CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PITI51
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIELD
AND STATE THAT TME ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL
I HEREBY CERTIFY THAT t AM PROPERLY REGISTERED AND/OR. ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM ---
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A E DEBCRI/B�EO RESIDENTIAL PROPERTY. ABANDON H_USE_SEWER
SIGNATURE /J� z/ BACKFILL SEPTIC TANKS ❑
OF PERM ITTE VV V/'✓/ G ❑
SEEP.PIT 151 ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK: M.O. CASH
LK-08 1 2 5- FEB 1 1 1 D 2 5.00-
K
M Mll LE CUTY
Y fl-
76A6633•GER06 8.62 APPLICATION FOR ELECTRICAL ,PERMIT.
COUNTY OF LOS ANGELES _
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER - a °
WILLIAM A. JENSEN,SUP'T OF BUILDING LOCALITY\ /1 q%
.NEAREST
FOR APPLICANTTO FILL IN A CROSS ST.
RECEPT.� TOTAL NO. EACH FEE -/
�q 1It OUT ETS
(FIRST 20 S.2O $ OWNER'
LIGHT JJ I --
-
SWITCH:�3 ADD'L y O 1O av ADDRESS
OVER 2O J "LJ
TOTAL ('+ CITY TEL. NO,
LIGHTING FiR5T 201 IJ .20 -
FIXTURES } Aoo'L ap ELECTRICIAN '� ar Q%' /!1d
OV R20 - /` �q�O
RANGES CLO.DRYERS WTR.HTRS. 1:DD ADDRESS. l�
STA.COOK GARB.DISP I 3 J YO(/
CITY CO it °EL. NO.
OISHWASH. AUTO.�WA6X. _ STATE
SPACE HTRS. STA. MAX.) 50 VAC" 'LICENSE NQ `T2
MOTORS: OVER NOT OVER H.P. DIS'T7Cj NOG OUP NE' P OC /EG,.0 BY
O 1 1.00 Q O} !!&
1 3 - 1.50 ' INSPECTION RECORD
s s 2.00 �.
S Is 2.50
,is 50 3.00 6 '
4i 1 C O
50 — 100 5.00 U
4'Zo-�S= CE
SIGNS: , NO.TRANS,
NO. LAMPS 1 OCLT 1�• /CJS t (T O
SERVICE O.60OV-NOT OVER 200A (AOII '. CO3N)O17IDA-) V
W
SERVICE 0-60OV+OV ER 200 A. 2:001 - N
SERVICE OVER 600V 5.00 - - ?
U
MISC.
PERMIT ISSUING FEE 2100 1.1i
- -
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE 6.�� FIRN 1 HEREBY ACKNOWLEDGE THAT 1 HAVE BEAD THIS APPLICATIONDATE INSPECTOR'S SIGNATURE
AND STATE THATTHE-ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL 'COUNTY ORDINANCES AND STATE LAWS REGULATINGELECTRICAL WIRING.1 HEREBY CERTIFY THAT I 'AM PROPERLY REGISTERED pNDIDRLICENSED AS REQUIRED BY LO6 ANGELES COUNTY AND 9YATE.OF ' a XiAAaCALIFORNIA OR THAT ( AM THE LEGAL OWN R.OF THEABOVEDESCRIBED RESIDENTIAL PROPERTY.SIGNATURE FIED hAI L
OF PERMITTESI� 12M
FINAL — � II A
LIDATION ARTHUR C:VEIT Rf
CK- MO ',CASH SUPERVISING ELECT/CAL ENGINEER
LiAC,0 8 7 6 3- fr81 9 2 D 1 4,10-
Z
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