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Home My Public Portal About10633 DAINES DR_Sewer__ ,D-BZ 70A64ZAPPLICATION FOR PERMIT TBAae COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A, LAMBIE, County Engineer ADDHEss WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO.21�J 4, Z OWNER ' MAIL BLOCK TRACT 4•'YI 6�, ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS '�� DISTRICT NO. GROUP MAP PROLE$ BY BK PG CONTRACTOR L SD X99 /J L ADDRESS CONNECTION DATA L /•1 _ l DEPTH/V CITY ? ✓X TEL. NO. STATE MANHOLE REFERENCE /[ REGISTRATION NO. g COIL%Y NO. DESCRIPTION F WORK FEE TY E ONNECTION LENGT FROM HOUSE SEWER CONNECTING TO B .L, ALL.T P.L. V PUBLIC SEWER 0 $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO, PITS ANO/OR DRAINFIELD SOOO CO. IMP.NO, UOB NO. HOU 5E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT A .O PRIVATE DISPOSAL SYSTEM 53.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I 'Alve. NI RECORD,INSTR.NO, DATE WORK TO HOUSE SEWER S.O.OVERFLOW SEEPAGE PIT.DRAINFIELD E%TN.,CESSPOOLORYWELL.MAN H OLE@ $5.00 f Ri ALTER.REPAIR OR ABANDON HOUSE .0HWY.O T. IDENI L SEWER OR DISPOSAL SYSTEM 530 STATE O CHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT E z 00 CHARGES AUTHORIZATION I TOTAL Fee 1 7 1,0,0CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS—fDAY OF1 �I v OWNER OR NEW EWER OWNERS AGENT �4JCONNECT ADDITION AL A, ADDRESS 1-1 BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TA NK,SEEl.FIT IS) ANO` STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY AND/Ofl DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ElDRYWELL El I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED ANO/OR ALTER,RE PAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE A VE OEB IB O RESIDENTIAL ROPE TY. ABANDON HOUSE SEWER SIGNATURE / ❑ OF PERMITTE BACKFILL SEPTIC TANKS BEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD N.C. CASH SUPERVISING MECHANICAL ENGINEER CK, L1ihD 7 7 3 8' JAN 21 1 0 D 7,0 0� r CB 64 808 12 D °� 76AAPPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION "A..ESG /O JOHN A. LAMBIE. County Engineer WILLIAM A. JENSEN, Sup't of Building FOR APPLICANT TO FILL IN LEGAL �$ —$ DESCRIPTION LOT NO .S G lw Q BLOCK TRACT r� NO. OF LIMBS. SIZE OF LOT NOW ON LOT CITY _ TEL. NO. USE OF f, BUILDINGS ��J� DI6TftICT O. GROUP MAP PROLES DBV qq BK PG CONTRACTOR SU� I �l L- ADDRESS CONNECTION DATA CITY TEL. NO. ION 7\ C DEPTH/O J J ❑ STATE MANHOLE REFERENCE REGISTRATION NO. O ' ❑ COUNTY / WER NO, I DESCRIPTION OF WORK FEE ypE F _NECTION ENGTH FROM HOVSE SEW ER CONNECTING TO P.L. M.L.TO P.L. ' V HOU L SEWER C 35.00 pC NO SEPT ANGj. .SEEPAGE PtT OF CO.IMP. NO. -3 JOB NO. (� PITS AN AN. GRAINFIELD HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMI OIJ�)r PRIVATE DISPOSAL SYSTEM @ $3.00 CONN ECT A DO ITI ONAL B LOG.OR AFFIOAVIT FIV 5[MF RECO RD, INSTR.NO. DATE W OR K TO H OVSE S EWER III 33.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOLDRYWELLMANHOLE Q 85.00 ALTER.REPAIR OR ABANDON HOUSE HW 9T. C SEW ER OR DISPO AL YSTEM It $3.00 STATES NCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT E CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALSDATE INSPECRI)Ruj51 NATURE SIGNED THIS�1�DAY OFIS _1 OWNEROR V NEW HOUSE SEWER v OWNERS AGENT /V / CONNECT ADDITIONAL F/ ADDRESS BUILDING OR WORK nl SEPTIC TANK,SEEP.PIT(S) n/V I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIELO AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORUINAN CES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑ I HEREBY CERTIFY'THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER - I , 1 LICENSED AS REOVIRED BY L05 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE pB0 SIGNATV RE D CP RIBED RESIDENTIAL ROPERTY, ABANDON HOUSE SEWER OF PERMITTEE ! BACKFILL SEPTIC TANKS ❑ SEEP.PIT ISI ❑ CESSPOOLS ❑ OVALIDATION ROBERT A. WOOD cK M.O. CASH SUPERVISING MECHANICAL ENGINEER ;;� 7 7 3 9 BG iAN 21 1 1 0 25.00-