HomeMy Public PortalAbout10630 DAINES DR_Sewer__ ]6A642D
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APPLICATION. FOR, PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE, DISPOSAL
DEPAATMENT'OF QOUNTY"ENGINEER• ;- - - -
BUILDING 'AND SAFETY DIVISION 'Buu°ING
'ADDRESS"' ,6' O' '•• �" �V
IOHN'A.'LAMBIE, County Engineer - `
WILLIAM:'A. 1ENBEN, Supt of Building • rLOCALITY
F_OR APPLICANT T_ O,`FILL INGROSS ST.
l�.
LEGAL, :OWNER'
DE,
CRI TION it LOT NQ < -
BLOCK TRACT �0 - 'MAIL _
ADDRESS
NO.OF BLDGS. -
SIZE.OF LOT" NOW ON LOTCITY .TEL NO _
USE OF DISTRICT 0. GROUP ^MAP- P OCESSED BY
BUILDINGS
CONTRACTOR F - - - - /1 Y I / f
BK PG
ADDRESS Qe /9&,,e !`/UQ- C.tO'NFN-ECTiON DATA '
CITY. `. TEL.NO. r - OsSTATION rc - 0 3 1---? Durk
;MA
/+ / ❑ STATE N—HOLE-REP'P' RENCE UPPER
REGISTRATION NO. I "-3 O 1 DTZ ❑ COUNTY 3 LOWER
No. DESCRIP ON.OF
HOUSESEWER.CONNECTING TO
PUBLIC SEWER - @ $3.00 ��M � '.TYPE OF CONNECTION • LENGTH FROMSEPTIC • J' -
PITSAND/OR' SEEPAGE DRAINFIELDIT OR @ $3,00 Y. CURB P.L. M.L.TOP,L.
OVERFLOW SEEPAGE PIT,GRAINFIELD Q�C.
'EXTN.:C ESSPOOL. DRYWE LL @ S2.00 _ P..
O.NO.
,HOUSE EW ER CONNECTING TO pp
S
PRIVATEA ISPOSAL SYST EM @ $1.00 CO:IMP..NO. �J� JOB NO:
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT:NO. ROAD PERMIT NO. p
WORK TO HOUSE SEWER @ $1.00 O
ALTER,-REPAIROR ABANDON HOUSE - STATE ENCROACHMENT
•SEWER 0 DISPOSAL SYSTEM @ $1.00 M' .PERMIT N0; Q
V 14VO 'INDUSTRIAL V
-WASTEAPPROVAL - {�
CHARGES
OWNERS "PERMIT g - .2 00 - CON NECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE " 00 REIMBUMEkilif FEE
I HAVE.AT THIS.DATE A CONTRACT'WITH THE HEREIN NAMED CON- _ _ __
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING. - APPROVALS DATE. INSPECTOR''.SIGNATURE .,
TO THE PUBLIC SEWER.
SIGNED THISDAY OF 19— NEW HOUSE SEWER
OWNER - / +YM /t. CONNECTADDITIONAL
r OW NERS A AGENT ����1111��i�llllY - BUI LDING OR WORK -
ADDRESS SEPTIC TANK,SEEP.PIT(S) -
AND/OR DRAINFIELD
I HEREBY 'ACKNOWLEDGE-THAT-] .HAVE READTHISAPPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY CESSPOOL [] ORYWEIL ❑
WITH ALL COUNTY ;ORDINANCES AND STATE LAWS REGULATING ,ALTER,REPAIR,:SEWER.OR
PLUMBINGiAND SEWERS.' - - -
I HEREBY'CERTIFY THAT I AM :PROPERLY ;REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS. REQUIRED BY LOS ANGELES-COUNTY. AND, STATE OF DIS CONNECT PLUG AND
CALIFORNIA OR THAT. I AM T E LEGAL OWNER QF' THE ABOVE ABANDON HOUSE SEWER. -
DESCRIBED RESIDE T L PROP4' ,BACKFILL SEPTICTANKS❑ -
SIGNATURE. �,(/p` h_ y._{- .SEEP.PIT.(') ❑_CESSPOOLS:
"OF PERMITT Y' /_
®r • - 1 VALIDATION ' ROBERT A..WOOD - -
�tQc.\ Y.o. CASH SUPERVISING•MECHANICAL ENGINEER
1G,9`6 .9 a JUL 7 1 0 ' 2 5.0_0 1
6565 t� ERTS'
0E8O8°-s° APPLICAT: ON'; FP
76A6C3D PERM IT.
-
'
COUNTY OF LOS ANGELES SEWER,,=SEWAGE DISPOSAL 1
._.DEPARTMENT OF COUNTY ENGINEER = ._.
I' - .BHI LDING • • '
BUILDING AND SAFETY DIVISION 'aDDREss O; QG�111•v= '
JOHN A. LAMBIE. County Enggineer. '- - -
WILLIAM A. JENSEN; Suet of,HMildiMg LOCALITY- - t'
. ... :. - 'NEAREST. .
qq OR APPLIC tA�NT TO FILL IN _ ACROSS ST. —
D
LEGAL
RI A 1Ml1 J LOY ND. /O pfir OWNER' -
....,.,
B^: . TRACT `MAIL .. ., - .. -
6 O ADDRESS
NO:OF BLOCS. - - -
BIZEOFLOT NOW ON LOT _ ! 'CITY TEL. NO. ,•,
e BUILDINGS �' DIET GROU BK _MAP PG I--- , OCESSED BY
c VV - d— ^
CONTRACTORbvilLLI
ADDRE _ CONNECTION DATA
CITY L N -dt7/x� STAT
'� DEPTH / -
' _ / STATE MANHOLE FERENCE
REGISTRATION N0. . KJ ��� COUNTY �/ LOWER r
NO: DESCRIPTION OF WORK FEE-
HOUSELSEWER CONNECTING TO •._PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGEPITOR TYPE OF CONNECTION .LENGTH'fROM 7„
PITS ANDLOR DRAINFIELD @ $3,00 - Y. CURB P.L. M.L.TOP.L. d�
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN., CESSPOOL. DRYWEL L @ 52.00 -
HOUSE SEWER CONNECTINGTO - pp
PRIVATE'DISPOSAL'SYST EM @ 5I.00 CO.IMP. N0. ✓ J JOB NO. - p.
CONNECT ADDITIONAL BLDG.OR - T
WORK TO HOUSE SEWER @ $1.00. RUNK'PERMIT-NO.' ROAD PERMIT N0. 6 V
_
ALTER,REPAIR OR.ABANDON HOUSE STATE ENCROACHMENT -
SEWER OR DISPOSAL SYSTEM @ si.00 PERMIT N0. op
_ .INDUSTRIAL p
._ WASTE APPROVAL a
- - .CHARGES
-
OWON�ER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTI"IORIZA1TION' TOTAL PEE FEf MSURSEMEMTFEr `
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN:NAMED CON-
TRACTOR TOCONNECT'THE•ABOVE`DESCRIBED'EXISTING DWELLING' S -APPROVALS, - - .DATE INSPECTORXSIGNATURE r
TO THEPUBLICSEWER.
SIGNED-THIS` DAY OF - - - 19 NEW HOUSE SEWER - — �GY/s J� --
t
OWNER OR - 1 wi ^A
OWNERSAGENT L"l BUILD]CONNECT A"
-. -. - _ '. .. .BUILOING.OR•.WORK,_
ADDRESS ANVORiDRA1NFEELPIT(S)IT(S) -
I .HEREBY ACKNOWLEDGE.THAT '1_HAVE.READ..THIS APPLICATION.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑� DRYWELL.❑.
WITH.IALL COUNTY ORDINANCES' AND STATE LAWS REGULATING ALTER,8EPAI R;,SEW ER OR
PLUMBING AND SEWERS: SEWAGE DISPOSAL SYSTEM -
P HEREBY,CERTIFY THAT I AM.PROPERLY.REGISTERED. AMD/ORDISCONNECTTLUG AND _
LICENSED AS,- ABANDONIHOV3E-SEWER"
REQUIRED BY COS ANGELES COUNTY AND - -- +
CALIFORNIA OR THAT I AM. T E LEGAL OWNER QF THE ABOVE - _
DEECRIBED,RESIOE AL PROPyyy,,,� ! BACKFILL SEPTIC TANKS ❑
'SEEP. PIT.(S) ❑.CESSPOOLS ❑SIGNATURE, /YM/�'•C/ J4" - - 1 -
OF'PERMITT
o®
LIDATIO N .. . . . V ROBERT NGMEC A. WOOD .
cK.
M.0. CASH' ,SUPERVISING MECHANICAL ENGINEER
' Lt 0 9 6 9 7 w JUL 7's 0 [j :~ -5.0,0. i°