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Home My Public Portal About10623 DAINES DR_Sewer__ 7Beae2B.BB APPLICATION FO • T (� COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING O Z3 ,� A N E.S ADDRESS ll� A JOHN A. LAMRIE. County Engineer CASSATT D. GRIFFIN. Sup t of Building LOCALITY _ .. - .... ,- .. ..... NEAREST � x FOR APPLICANT TO FILL cRoss sr. I d LEGA�IJ,. OWNER DESCRIPTION LOT N0. //--'' 'h BLOCK �. TRACT MAIL /rd�� _ZA A /@ ADDRESS �J /� NO.OF.B LOGS. SIZE OF LOT O d NOW ON LOT CITY �- TEL. N0. USE OF - ` DISTRICT N0.yG I BK MAP- PG I ES Y __BUILDINGS (,j,^( sJl CONTRACTOR G ADDRESS CONNECTION DATA CITY TEL.NO./, ��j I ON DEPTH STATE MANHOLEREFER NC ' REGISTRATION NO. COUNTY NO. DESCRIPTION OF WORK. FEE �O�^ ` / HOUSE SEWER CONNECTING TO I lT/. )f, 1x C NL- � [� �^•U. •^� A�A/K PUBLIC SEWER @ $3.00 TYPE OF CUNNECTIONP LENGTH FROM A PITS SEPTIAND/OR DRAINFIEDTANK.SEEPAGE PIT OR @ $300 Y. CURB P.L. M.L.TO P.L. OVERP LOW SEEPAGE PIT,DRA1 NFI ELD �p EXTN., CESS POO L.DRYWE LL @ $2.00 HOUSE SEWER CONNECTING TO "'3 " P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. _ "� JOB NO. CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT N WORK TO HOUSE SEWER @ $1.00 ALTER.REPAIR OR ABAN OON HOUSE S EW ER O R O ISPOSAL SYSTEM @ $1.00 p,EB.161,T,N,G�+ .f�I.LJ �xT 9�rN iV v94jyL°JI /71 INDUSTRIAL WASTE APPROVAL CHARGES OVVNEgS PERMIT y 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 0_0 S REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN.NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS GATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. // SIGNED THIS DAY OF 1S— NEW HOUSE SEWER 7it7 III OWNER OR CONNECT ADDITIONAL OWNERSAGENT 1 s!_A I BUILDING OR WORK - ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGSE AND CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE WER DESCRIBED RESIDEN IA PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE S P. PITIS)AACESSP924S ELI I) OF PERMITTE �.r VALIDATION' ROBERT A. WOOD CK, M.B. CASH SUPERVISING MECHANICAL ENGINEER' Eeob D. CAPPLICATION FOR PERMIT eeoB eau COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION AIINE sG - IGRN A. LAMSIE, County Engineer INES CASSAIT D. GRIFFIN, Suet of euildinQ LOCALITY G ST. v*vmi5 J7 L FORPPLIROSS ANTO ACT FILL IN t LEGAL ag y7/ OWNER C J-,& .J DESCRIPTION LOT N0. // BLOCK TRACT // I J A DRESS ,'T O NO.oO BLDGS. SIZE OF LOT 0 /b NOW ON LOT CITY TEL. N0. d9 Af-V USE OF BUILDINGS DISTRICT N0. OUP PG MAP PR ESSED �� GRBK CONTRACTOR 4: O ]�, t / ADDRESS CONNECTION DATA CITY TEL.NO. h a 4e�E�t<>jy TION• DEPTHTATE / REGISTRATION NO. J-� B e COUNTY MANHOLER FERE/CE NO. DESCRIPTION OF WORK FEE / / �Ja, HOUSE SEWER CONNECTING TO / 3 C70 , w GIYGf4 PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. RB P.L. M.L.TO P.L. PITS ANO/OR DRAINFIELD @ 43.00 / OVERFLOW SEEPAGE PIT.DRAINFIELDAa 'Al 9 -5 EXTN,.CESSPOOL.DRYWELL @ 42.00 HOUSE SEWER CONNECTING TO P.C.NO. !� PRIVATE DISPOSAL SYSTEM @ 41.00 CO.IMP. N JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. 7 WORK TO HOUSE SEWER @ $1.00 SEWER OR DISPOSALABANDON SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL w WASTE APPROVAL CHARGES OWNER'S PERMIT $ CONNECTION CHARGE FEE ' AUTHORIZATION TOTAL FEE �� REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE ' TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19— NEW HOUSESEWER L. Q� OWNER OR - , / CONNECT ADDITIONAL OWNERS AGENT— BUILDING OR WORK SEPTIC TANK,SEEP. PIT(5) ADDRESS 7 AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL //� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA•.PROPERTY. BACKFILL SEPTIC TANKS ❑ SEE,?.PIT(S) ❑ CESSPOOLS SIGNATURE OF PERMITTE 12 .4 4 ®r _ VALIDAT ROBERT A. WOOD' _ CK. M.0. CAstl SUPERVISING,MECHANICAL ENGINEER �_riUD 2 8 2 8 JUN 2 7 1 i D 2 5 .0 0