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HomeMy Public PortalAbout10808 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER=SEWAGE DISPOSAL A DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION Y COUNTY OF LOS ANGELES $' WILLIAM J. FOX, COUNTY ENGINEER DUILOING ADDRG NO ESS FOR APPLICAp-N�T TO FILL(DA LOCALITY }�7 NEAREST ADDDU'LRESS Z000Q2 ,C {Jn<,rLL.. DA CROSS ST. .0 I �/ LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO. NEAREST A 71 S-4 �� 8 9 CROSS SL RECEIVE`O B�Y� Rend,for I.w.U.a DATE ISSUED OWNER a (} p ADDRAl LESS ILII D/ e �.J�Jj3A�,[/�,_. USE ZONE OCCUPANCY BK MAP PG CITY Y.� &,C, TEL.KO �5 CONTRACTOR �� CO.IMP.N0. ADDRESS -roof g AO L `V )OB N0. CITY TEL.NO STATE TRUNK PERMIT NO. /'YJ / p REGISTRATION N0. /P6 ry ❑ COUNTY ROAD PERMIT N0. LEGAL STATE ENCROACHMENT \ DESCRIPTION LOT N0. PERMIT N0. BLOCK TRACT INDUSTRIAL N0.OF BL WASTE APPROVAL SIZE OF LOT NOW ON LOT CHARGES, USE OF BUILDINGS CONNECTION CHARGE FEEL' \ NO. DESCRIPTION OF WORK. FEE \ HOUSE SEWER CONNECTING TO /�/ REIMBURSEMENT FEE PUBLIC SEWER � S 3.50 *79; RECEIPT N;C GATE \IBY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 / CONNECT ADDITIONAL.BLOG.OR B EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTEROR REPAIR EXISTING. NO- DATE IBY�- SEWER OR DISPOSAL SYSTEM 1.00 6 DISCONNECT AND ABANDON SEWER ANO/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITSAND/ORDRAINFIEID 2.00 STATION ' ;-�R '7 / DEPTH CESSPOOL—O RYW ELL SPECIAL CONDITIONS ONLY 2.00 /9^� 4,I / MANHOLE REFERENCE 7S, . UPPER LTWER TYPE'OF CONNECTION LENGTH FROMC _ OWNERS PERMIT S I 00 �V CURB Pr M.L.TO P.L. J� AUTHORIZATION ' , TOTAL FEE �f_ d 1 M� `+-, 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGI DWELLING TO THE PUBLIC SEWERAPPROVALS INSPECTOR'S SIGNATURE DATE SIGNED THIS..----- ../7...DAY OFF-----✓�.}�/ ,.d.. ,...._._._. 19.1.:. NEW HOUSE SEWER OWNER OR i 1/ ./!/_U CONNECT ADDITIONAL OWNERS AGENT.... r -. .- �x.A BUILDING OR WORK _ �cJL . SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR ANO/OR GRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL 0 DRYWELL I] CATION AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN; ABANDON HOUSE SEWER _ ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS�❑I /A 1��Q of r p� - � �J SEEP PIT(S) CESSPOOLS 'y L / �i" 8- SOF PERMRITTEE Vd(.L..i..G._©'.--wo ..-�. C l:'G!_-...... 76A642D 663 1/53