HomeMy Public PortalAbout10820 DAINES DR_Sewer__ - -- -E to
CE B92e0.82
7Ad42DAPPLICATION FOR PERMIT
. �J
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
..BUILDING AND SAFETY DIVISION eUIIDING 1U620 E. Daine5
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building ewe City
LOCALITY
NEAREST DoubleDrive'
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL Garner
DESCRIPTION LOT NO. Ci OWNER
MAIL acne
•BLOCK TRACT BADDRESS
NO. OF LOTS. - ,
'BILE OF LOT NOW ON LOT � CITY TEL. NO.
,USE OF DISTRICT NO.GROUP MAP BY
BUILDINGS
Alcadia Plb' Co S U $ r pT
pROCES ED
CONTRACTOR br -
ADDREss Tn. TO-14C.ZiV2 03k 101
CONNECTION DATA
CITY. EL. NO. / STATION O `-]- ;..� Y .DEPTH
STATE MANHOLE REFERENCE } R t
REGISTRATION NO. COUNTY ELM
WER.
NO. DESCRIPTION OF WORK FEE TYPE OF TION LENGTH FROM
C"
TION
TO V. URB P.L. M.L.'TO P.L.
PUBLIC SEW ER C 35.00 PC NO `J
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR'DRAINFIELO 510.00 CO. IMP. NO. JOB N0.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N0. -
PRIVATE DISPOSAL SYSTEM n6 83.00
CONNECT ADDITIONALB LOG.OR _ _ AFFIDAVIT' AIY ♦SIMS TR. NO..RECORO.INSDATE
WORK TO HOUSE SEWE R S3.00 _
OVERFLOW SEEPAGE PIT.DRAINFIELD to
EXTN..CESSFOOL,DRYWELL.MANHOLE $5.00 . HWY.OR ST.WIDEN INT
ALTER.A OR E 100 v
SEWER OR Bi6OQ64L SYSTEM 33.00 J STATE.ENCROACHMEN
NO.
IITI INDUSTRIAL
WASTE
WASTE APPROVAL
_ OWNERS PERMIT $ z 1{ CHARGES oo -
AVTHORIZATION TOTAL FEE CONNECTION 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 PUB IC SEWER. APPROVALS DATE INSPECTOR5 SIGNATURE
SIGNED THIS DAV OF 19_
OWNER OR' - NEW HOUSE SEWER'
'OWNERS AGENT
CONNECT ADDITIONAL )
ADORES S^ BUILDING K.WORKSEPTIC Y
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANU/.TANK.SEEP PITS)
AND
STATE THAT THE ABOVE IS,CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELO
WITH ALL COUNTY ORDINANCES ANO TE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑ A`
I- HEREBY CERTIFY 'THAT I PROPERLY AEGIS D NO/OR ALTER REPSYQ,SEWER OR
,LICENSED AB.REOUIR_ED_.BT_ S. ANGLES.COUN AND TATE OF 815 SYSTEM_
CALIFORNIA OR THAT AM E'LEGAL OWN F AN TE TO J �♦
RESIDE IN; THE`w BOVE'I CRIBE RESIDEN AC PROP DISCONNECT H PLUG AND
ABANDON HOUSE SEWER
SIGNATURE A
OF PERMITTEE BACKFILL SEPTIC.TANKS ❑ - -.
SEEP.PIT(B) ❑ CESSPOOLS ❑
/VM.O. CASH ALIDATION ROBERT A. WOOD —
(( SUPERVISING MECHANICAL ENGINEER
CK.
__ ,► 9,2:ws a nuc"23 10-n
. . .... .....
CE 6 2/T°
76A 5620 APPLICATION FOR. PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER /,kA;7ef9 10A
ADDRESS L+A
COLEMAN W. JENKINS. SUPT. OF BUILDING _
LOCALITY T
FOR APPLICANT TO FILL IN NEAREST
(PRINT OR TYPE ONLY) CROSS Si. G'
LEGAL /
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS
A NO. OF SLOGS,
S I2E OF LOT NOW ON LOT CITY TEL. NO. 7] 7--
USE OF p
BUILDINGS eC(do't �, DISTRICTND. GROUP CLAS$ MAP PgOCE55EO BY
/J BK p5
CONTRACTOR „ S OCJ .T r / Q 9
ADDRESS CONNECTION DATA
CITY TEL. NO. yeO STATION DEPTH
STATE LIC - MANXOLE REFERENCE UPPER
LICENSE NO, O CLA55 LOWER
NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
OUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLI CSEWER
SEPTIC LANK.SEEPAGE PIT OR P.C.NO.
PITS ANO/OR PAGE
® 510.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO }
PRIVATE DISPOSAL SYSTEM 53.00 TRUNK PERMIT NO. ROAD PERMIT NO. a
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT uv p5[.[xT, RECORD. NSTR.NO. DATE O
WORK TO HOUSE SEWER ® $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EATN,.CESSPOOL.ORYWELL.MANHOLE $5.00 O
AIIIri REPq IRdY�YiililllllON HOUSE XWY.OR ST.WIDENING
SEWER OBiYIY1/. ® 53.00 �J
STATEENCROACHMENT W
PERMIT NO. d
INDUSTRIAL h
WASTE APPROVAL Z
OWNER'S PERMIT s �o�
CONNECTION CHARGE FEE CHARGES
AUTHORIZATIONTorAl FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON." REIMBURSEMENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED E%ISTING DWELLING
TO THE PUBLIC SEWER. - APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19
OWNEROR' NEW HOUSE SEWER
OWNERSAGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEEP.PIT IS)
AND/OR DRAINIIFIELD
AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL DRYW ELL ❑
HEREBY CERTIFY TH'Trl-aM PROPS ` REGISTERED AND/OR ALTER R$PAI SEWER OR
LICENSED AS REQUIRED BY LOS ANG 5 COV NT AND STATE OF SEWAG OSAL SYSTEM i
CALIFORNIA OR TH/yT AM THE LEG OWN AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE OVE DESCRI SEO RESIDE PROPERTY.
ABANDON HOUSE SEWER
51GNATU REQ BACKFILL SEPTIC TANKS ❑
OF PERMRT
_ SEEP.PIT ISI ❑ CESSPOOLS ❑
,_-�VLIDATION JACK R. ALLEN
M.o. cwsH SUPERVISING MECHANICAL ENGINEER
0 9 3 MAY 410 0 9.00A58