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Home My Public Portal About10619 DAINES DR_Sewer__ ,6A64 10'62 APPLICATION FOR PERMIT c E808 D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F ILDING •�46 JOHN A, LAMBIE, County Engineai Gaess WILLIAM A. JENSEN, Sup't of Building G CALITY AREST FOR APPLICANT TO FILL IN CRO5. ST. f— LEGAL OESC RIPTION LOT NO.F`T F Lo -J OWNER MAIL BLOCK TRACT _ ADDRESS NO. OF SLOGS, SIZE OF LOT NOW ON LOT CITY _TEL, NO. USE OF BVILDI NGS DISTRICT ME]GROUP MAP PR01E55E0 BY CONTRACTOR A/I Lt-OLTIL !I AQG ADDRESS VF4,6 J�X ,C/ 7 CONNECTION DATA _ CITYAWz TEL. NO. STATION DEPTH L3 STATE UPPER REGISTRATION NO MANHOLE REFERENCE❑ COUNTY LOWER NO. DESCRIPTION WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBI_ICSEPTIC AN ER E5.00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. NO PITSAN D/ORGRAINFIELD @ EIO.00 -- CO.IMP. ERNo. JOB PER HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVIR [/.SEnIRT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER OVERFLOW SEEPAGE PIT.GRAINFIELD E%TN.,CESSPOOL.DRYWELL,MAN HO LE@ $5.00 M1�1Y!T!l�Y�Yltw BANOON HOUSE Jam/') HWY,OR ST,WIDENING SEWER SYSTEM 53.00 t.F I/ STATE ENCgOACHMENT PERMIT NO G� INDUSTRIAL WASTE wPPROVAL CHARGES OWNERS PERMIT s z o0 AUTHORIZATION TOTAL FEE `� ONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVAL GATE INSPECTOR'S SIGNATVftE SIGNED THIS DAy OF—��/ —19_ OWNER ®A'f /D NEW HOUSE SEWER OWNERSAGENT �L/.F / CONNECT ADDITIONAL ADDRESS BUILDING OR WORK HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP, PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELT_ ❑ IHEREBY CERTIFY THAT I 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 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AN RESIDE IN. THE ABOVE DE:C D RESIDENTIAL PROPERTY, ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT I51 ElCESSPOOLS ❑ ALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER Ln%D 7 2 6 9IG JAM 5 1 0 0 5.0 0~ L 1 6A64 I�0-63 APPLICATIONFOR PERMIT I� C IE80 1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONDING JOHN A. LAMBIE, County Enginee. RESS - WILLIAM A. JENSEN, Sup't of Building y, LITY EST FOR APPLICAN T F ' 74. S ST. EGAL / DESCRIPTION LOT NO. CSVER _ MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO: USE OF DISTRICT NO, GROUP MAP PROCESSED BY BUILDINGS ✓�/ V BK PG 15/ CONTRALTO LJ� L '1 5j L ADDRESS / CONNECTION DATA CITY TEL. NO. G STATION DEPTH REGISTRATION NO. „2 ❑ COUNTY MANN.LE REFERENCE /'(�. •T `� V - NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM H OUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 d SEPTIC TANK.SEEPAGE PIT OR P.C.NO. O PITS AND/OR GRAINFIELD C $10.00 CO.IMP. NO. lOB NO. U HOUSE SEWER CONNECTING TO v P RIVATE DISPOSAL SYSTEM @ S3.00 TRUNK PERMIT NO, ROAD PERMIT NO. 0CONNECT ADDITIONAL BLDG.OR AFFIDAVIT *AiVEP S[N[Ni RECORD,I NET.,NO. DATE WORK TO HOUSE SEWER @ S3.on ]V, OVERFLOW SEEPAGE PIT,GRAINFIELD W E%TN.,CEESPOOL,DRYWELL.MANH O LE@ $5.00 ALTER.REPAIR OR ABANDON MOUSE HWY.OR ST.WIDENING LO SEWER OR DISPOSAL SYSTEM S3DO STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT t z 0 0 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 'IHAVE 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 INSPECTORS SIGNATURE SIGNED THIS DAV 19_ 7 , _ - OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL .It f n ADDRESS _BUILDING OR WORN I HEREBY ACKNOWLEDGE THAT I HAVE READ TNT APPLICATION SEPTIC TANK,ANK,BIELD PIT(S) ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ANO/OR DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ HEREBY CERTIFY THAT I 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 I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCRIBED RESIDENTIAL PROPERTY, ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILLSEPTIC TANKS ❑ SEEP, IT IS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD cK. M.0. CASH SUPERVISING MECHANICAL ENGINEER iGos 11 z '�'J FEB 1 10 0 5.00- Q