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Home My Public Portal About10635 DAINES DR_Sewer__ 6AS42 0.BE 7APPLICATION FOR PERMIT CEBOB 1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS Al WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. , LEGAL ) //� DESCRIPTION LOT NO # OWNER MAIL BLOCK TRACT �a �.(7Y O ADDRESS D qQF BLOCS, SIZE OF LOT NOW ON LOT CITY BUIOF LDINGS NGB DISTRICT NO., OUP MAP PROCESS �Y L BE PG n CONTRACTOR ADDRESS . �y GG�� CONNECTION DATA CITY T.L. NO. A p el ATION DEPTH O r ❑ STATE MANHOLE REFERENCE REGISTRATION NO. 'f ❑ COUNTY ) LOWER NO. DESCRIPTION WO FEE TYPE F NECT ION LE TH FROM / d HOUSE SEWER CONNECTING TO Y. R .L. M.L.TO P.L. O PUBLIC SEWER @ 55,00 17161-n SEPTIC TANK.SEEPAGE PIT OR P.C.NO. V CO.IMP. NO. JOB NO. PITS AND/OR GRAINFIELD @ 510.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. gppD PERMIT N PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONALBLDG.OR AFFIDAVIT Ery u5[x[xr RECORD.INSTR.N DATE WOflK TO HOUSE SEW$EWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELO ' EXTN..CES5POOL.DRY WELL.MAN HOLE @ 55.00 L ALTER.REPAIR OR ABANDON HOUSE HWY.O ID 1 SEWER OR DISPOSAL SYSTEM _ @ 53.00 STAT ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s z o0 CHARGES AUTHORIZATION TOTAL FEE —1 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CO, REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THISD"""A��'Y OF 19_ OWNER OR // �/\ NEW HOUSE SEWER OWNERS AGENT/D /� �' CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) IMEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELO AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB ESCRIBED RESIOCNTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE �y�. BACKFILL SEPTIC TANKS ❑ OF PERM ITTE SEEP,PIT(S) ❑ CESSPOOLS ❑ �]JALIROBERT WOOD cK. m..0.o. CaSH SUPERVISING MECHANICAL ENGINEER LCO7 7 4 0G JAN 21 1 0 0 7.00" h�l.Ct�rn� 76AO4 0 -S APPLICATION FOR PERMIT CE ESa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING -) TORN A, LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt o7 Building LOCALITY NEAREST FOR APPLICANT TO FILL IN �j CROLEAL SS BT. DESCRGPTI ON LOT NO / . -070 f VJ yy OW NEP MAIL � BLOCK TRACT M•� So ^� J[ POOflE55 NO, OF SLOGS. V SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCE$6 BY �' DK PG CONTRACTOR S,o � Pte/ ADDRESS CONNECTION DATA CITY TEL. NO. ION Y DEPTH STATE MANHOLE REFERENCE �J REGISTRATION NO. _ COUNTY LOWER NO. DESCRIPTION OF WORK FEE TY E F NNEGTIONLENGTH FROM 6 HOUSE SEWER CONNECTING TO URB P.L. M.L.TO P.L. O PUBLIC SEWER ® 35.00 SEPTIC TANK,SEEPAGE PIT On P.C.NO. (J CO.IMP,NO. , JOB NO. PITS AND/OR GRAINFIELD 510,00 �J� HO U BE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT ,[ PRIVATE DISPOSAL SYSTEM $3.00 _s V CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIY[P [.5[n[Hi RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER ® $3.00 OVERFLOW SEEPAGE PIT.GRAINFIELD 1/J E%TN..CESSPOOL.DRYWELL.MANHOLE 0 55.00 Z ALTER.REPAIR OR ABANDON HOUSE HWY.OR 5 NI G SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT PERMIT NO, INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT S CHARGES AUTHORIZATION TOTAL FEE tJ'a CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRI ED E%IBTING DWELLING TO THE PUBLIC SEWS APPROVALS DATE INSPECTORS SIGNATURE SIGNED THIS_ DAY OF 1 OWNER OR � d NEW HOUSE SEWER OWNERS AGENT �7 CONNECT ADDITIONAL BUILDING OR WORK 40 ADDRESS SEPTIC TANK.SEEP.PITIS) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ TRIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLO MRING AND SEWERS. CESSPOOL ❑ ORYIELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA Op THA AM TXE LEGAL OWNER OF. AND INTEND TO DISCONNE<T PWG AND RESIDE IN. THE A V 3C IBED I�SIDENTIAL TRpPER ABANDON HOUSE SEWER SIGNATURE S /y(J BACKFILL SEPTIC TANKS ❑ OF PERMITTE ❑ SEEP,PIT IB) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD crc."! M.0. CASx SUPERVISING MECHANICAL ENGINEER LUL77410 JAN2111 D 25.00-