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Home My Public Portal About10625 DAINES DR_Sewer__ TEMPLE CRTY >eAeetp APPLICATION FOR PERMIT ceeoe e.eR COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGKCITY BUILDING AND SAFETY DIVIING _ j E JOHN A. LAMBIE, County EngineSS CASSATT D. GRIFFIN, Sup of BuITY �— NEAREST A/+ L FOR APPLICANT TO FI �y� [ y LEGAL d? 3RDESCRIPTION LOT NOp '1/-�t-, A� AIL BLOCKS TRACT/RRLbyl///� SS DN0.OF BLDGS. ,SIZE OF LOT (� JoNOONLOT TEL. N0. e USE OF e^ BUILDINGS DISTRICT N0. GROUP BK PG MAP PROCESSED ✓ — CONTRACTOR 4g ADDRESS 5 J� CONNECTION DATA CITY �1 TEL.NO. Q 6e 44 c d> ION £j DEPTH f 0 STATE { MANHOLE REE REGISTRATION NO. /� O C COUNTY r1(.,,.:/ No. I DESCRIPTION OF IVRK FEE HOUSE SEWER CONNECTING TO C PUBLIC SEWER @ $3.00 YPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL. ORYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 .CO.IMP. N0. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N WORK TO HOUSE SEWER @ $1.00 ALTER, REPAIRABANDON HOUSE STATEME6rcGR0AtH HENT/� / 'ef/dl-1- h SEWER OR DISPOS L SYSTEM @ $1.00 INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE �5 O-e> REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR M _ .' / CONNECT ADDITIONAL OWNERS AGENT ' ! ,�>Z�`� BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYW ELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/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 RESIDEN IA PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.fvT(S) ❑ CESSPOOLS OF PERMITTE VALIDATION ROBERT A. WOOD Clt Y.O. GSN SUPERVISING MECHANICAL ENGINEER L;�o2329a JUd271 0D 5 .00 M Ea Oa 9 a-so casae APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 'BUILDING / Dl CLOS A. AM LBIE, County En o.T ADDRESS iG CASSATT D. GRIFFIN, Supt of building LOCALITYEAREST ' FOR APPLICANT TO FILL IN ROSS ST. LEGAL / r e DESCRIPTION LOT N0. –0,9/1 J � NER C /r.c ' BLOCK TRACT �/0� MAIL YY ADDRESS NO.OF BLDGS. SIZE OF LOT .-.?t NOW ON LOT CITY L TEL. NO. 2 USE OF BUILDINGS �� - DISTRICT NO. GROUP . .MAP °PR SEDBy CONTRACTOR I I K +]Gr ADDRESS r— 7 ,V CONNECTIOONe DATA CITY CITY TEL.NO.4 0G ON OL D DEPTH/� REGISTRATION NO, 3 O COATE UNTT MANHOLE R R CIF NO. DESCRIPTION OF WORK FEE SEWER ERCONNECTING TD PUBLIC @ $3.00 SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM / PITS AND/OR DRAINFIELD @ S3.00 Y. CURB P.L. M.L.TO P.L. / OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $ 2.00 HOUSE SEWER CONNECTING TOP.C.N0. /•. ��"Gr PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. NO. JOB N0. {�fJ WORK TOCONNECHOUSEISEWER LOG.OR @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO. ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. art It f (za INDUSTRIAL WASTE APPROVAL .CHARGES OWNER'S PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE 1 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 HOUSE SEWER OWNER OR /)/) �� CONNECT ADDITIONAL OWNERS AGENT/ BUILDING OR WORK / ADDRESS SEPTIC ANK.SEP. ANDARTDRAINFEELDPIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ 1 ° WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR - PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND ER LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGAHOUSE D CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI L PROPERTY. BACKFILL SEPTIC TANKS ❑ - BE PITIS) ❑ CESSPOOLS ❑ SIGNATURE , OF PERMITTE ®� VALIDATION ROBERT A. WOOD CK. b.0. CAstl SUPERVISING MECHANICAL ENGINEER U'I�A2830 AIN 2711 D 25 .0.0