HomeMy Public PortalAbout10629 DAINES DR_Sewer__ ' 5&E-G, APPLICATION. FOR PERMIT /0 �3h '
5'B E.GG312.54 11
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
" Deportment of County Engineer
" County of Los Angeles. .BUILDINDA
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` WM. J. FOX,,COUNTY ENGINEER ADDRESS D 7ejzz CASSATT D: GRIFFIN, SUPT of IsuLLDING LOCALITY �i p( AFOR APPLICANT TO FILL IN NEAREST
CROSS ST.LEGAL DESCRIPTION .LOT NO /� �,,,,,,rrr���,J///K��i✓ I OI/S✓IP 'OWNER BLOCK TRACT _' /— C/ ADDAI RESSyNO. OF BLOCS -SIZE OFLOT iC (I NOW ON LOT
USE OF q C i CITY �n'.y"�- TEL. NO.
BUILDINGS O DISTRICT NO. GROUP MAP
BK PG
' CONTRACTOR � .0 t +
ADDRESS p ;g CONNECTION DATA
CITY TEL.-NO.zfU STATION . ,��e2°0 DEPTH
STATE MANHOLE REFERENCE'.: I ,/
REGISTRATION NO. //}A• + LJ COUNTY )TY LOWER -
/ TYPE OF CONNECT IOy� LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB M.L.TO P.L. •9
`HOUSE SEWER CONNECTING TO J
'PUBLIC SEWER t�-0 S 3.50.
,HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. fy
,WOR,
WORK TO HOUSE SEWER EDO DQ - %�1 JOB. NO.
ALTER.OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
'DI SCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AHD/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
I'SEPTIO TANK.SEEPAGE PIT OR
_ PITS.AND/OR GRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2:00 CHARG
CONNECTION CHARGE FEE /
OWNERS PERMIT s 00
-
RUTFIORIZATION• -TOTAL FFE REIMBURSEMCNT FEE
I HAVE.'THIS -DATECONTRACTED WITH-THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE.ABOVE DESC IBED,EXI TING DWELLING - APPROVALS DATE INSPECTOR'S'.SIGNATURE
TO THE PUBLIC SEWER
L .e
♦_SIGNED THIS—.. "DAY NEW,HOUSE SEWER
bF 19 S
CONNECT ADDITIONAL 100
-�
OWNER OR - BUILDING OR WORK i
OWNERS AGENT
SEPTIC TANK•.SEEP, PIT(S),
ADDRESS AN❑/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE,READ THIS APPLICATION CESSPOOL El DRYWELL❑
•AND'STATE'THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR,SEWER OR
PLUMBING AND SEWERS. , - SEWAGE DISPOSAL SYSTEM'
1HEREBY CERTIFY THAT I AM' PROPERLY REGIS EREO AND/OR DISCONNECT PLUG.ANp
LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF DISCONNECT
CT PLUGEND
CALIFORNIA OR THAT 'I AM THE LEVOWN, OF THE' ASOVE DESCRIBED RESIDENTIA ROPERTY. BACKFILL SEPTIC TANKSSEEP:PIT(S) ❑CESSPOOLSSIGNATURE OF PERM ITT -
WILLIAM J. FOX.'CDu ENGINEER. 41f=ATI
'•,BY {1((',;aY� 5 �+s SEP 14 4 6.50
DEPUTY 1 DEPUTY °
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�V BY BY
h•® DEPUTY !!!///. DEPUTY