HomeMy Public PortalAbout10627 DAINES DR_Sewer__ ' APPLICATION
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cEsob .59 APPLICATION F'OR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BU
BUN.DING AND SAFETY DMSION ADDRESSG I NFT'
HN A. LADIDlE. CountF En ear
COSATT D. GRIFFIN, Supt of Building LOCALITY G
'-.. - - - NEAREST
FOR APPLICANT TO FILL IN cross sT. L n a7
LEGAL _ OWNER
DESCRIPTION LOT N0. I.'
BlG C TRACT A �� H d A DRESS D
OF SLOGS.
SIZE OF LOTOWM L CITY L TEL. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP P SSE B
CONTRACTOR T�Q � BK ✓ I
ADDRESS ® CONNECTION DATA r
CITY A. TTE�L.NO.),o (.F❑�pO y ION
y DEPTH
REGISTRATION N0. ,� ` O ( /y ❑ COUNTY MANHOLE REFERENCE
NO. 1 DESCRIPTION OF WORK FEE J
HOUSE
ER
SEWER
EW ECONNECTING TOPUBLICSE@ $3,00 �/i
TYPE 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. DRYWE L L @ $2.00
HOUSE SEWER CONNECTING TO 5 P.C.N0.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. N0. JOB N0.
WORK TO HOUSEISEWEBLDG.OR @ $I 00 TRUNK PERMIT NO. ROAD PERMIT NO
SEWER OR DISPOSAABANDON L SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT/ /�/ = . "
PERMIT N0. A / ( f�J /4'i/1LONK v
INDUSTRIAL /
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE DATE A CONTRACT THE CON. 6
TRACTORA TO CIONNECT THE ABOVE DESCRIBED EXISTIINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATU E
TO THE PUBLIC SEWER. e,f
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR ` CONNECT ADDITIONAL
OWNERS AGENT—��_ / BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,.REPAIR,SEWER OR
PLUMBING AND SEWERS. ALTER,REPAIR,
SEWERDISPOSAL EM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGDISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN A PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE S . PIT(S) ❑ CESSPOOLS CI
OF PERMITTE
®� ALMATIONt ROBERT A._WOOD
M.o. CAstl SUPERVISING MECHANICAL ENGINEER
tt 2 8 3 1 J"j%l 2 7 �. 0 5.00
C76
ROOS 8.50 APPLICATION 1'OR PERMIT
cseoe e.sa COUNTY OF LOS ANGELES
SEWER-SEWA E DISPOSAL
DEPARTMENT OF,COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION euaDING b. G7 YJA I AhEl
ADDRESS C
CRS
A. MB
LAIEoa
Cotp Eaquear
Cl�SATE D. GRIFFIN, SaP t of Huildinq LOCALITY r�
NEAREST
fi
FOR APPLICANT TO FILL IN CROSS ST.LEGAL
DA L
DESCRIPTION %3ON LOT NO.Pa/) -! OWNER jj CXqA A j. G
J .TRACT -MA fxA
NO.OF SLOGS. A
SIZE OF LOT NO%EN, T CITY TEL. N0._
USE OF
BUILDINGS k DISTRICT NO. GROUP EK I MAP PG PR ESSED
CONTRACTOR
ADDRESS I/ V CONNECTION DATA
CITY TEL.NO. a &� T TION r + DEPTH
STATE REGISTRATION NO. B
COUNTY ANHOLE REFERENC O r
No. DESCRIPTIO OF foRr FEE
HOUSE SEWER CONNECTING TO Ai
PUBLIC SEWER CO $3.00 TYPE OF CONNECTION LENGTH FROM
PETS AND/OR DRAINPTIC TANK, FIELDPIT
OR @ $300 Y. CUR .L. M.L.TO P.L. Z_
OVERFLOW SEEPAGE PIT,DRAINFIELD .�
EXTN.,CESSPOOL. DRYWE L L @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. 13 JOB N0.
CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 _
SEWER
ALTER,
OF DISPOSAL SYSTEM HOUSE @ $100 STATE ENCROACHMENT
PERMIT NO.
�� INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HE NAMED CON-
TO THE PUBLIC SEWER.TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19— NEW HOUSE SEWER G(7 �-•-"'
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT / BUILDING'OR WORK
ADDRESS n SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [IDRYWELL ❑ /
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 HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA P PERTY. BACKFILL SEPTIC TANKS ❑
EP. PIS) [ICES POOLS�C]
SIGNATURE TOF PERMITTE
®r ALIDATIOI,1 ROBERT A. WOOD
M,a SUPERVISING MECHANICAL_ �ENGINEER
2832a JUNI271 , c �.O0 r