HomeMy Public PortalAbout10835 DAINES DR_Sewer__ DEPART',VgnvT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING p C p
ADDRESS
F
R APPLICANT TO FILL IN LOCALITY
� `,� )'_' �• M o NEAREST ///� / / Q�Q —
JY' Ca/ M'V CROSS ST. N� zz"OISTRIO. SERIAL LA0. -PERMIT LA0.
A// Ready lar Inspection D E ISSUMAILpp '.. /C���Jpp1/ d`��jp.,-/'.,� /q _
ADDRESS IO�7J�N�T�/�L.�9 /✓/ftL U3E ZONE OCCUPANCY BK ff'A
PG
CITY TELNO. �/ I ��S /C::- �Q9
CONTRACTOR /Yep�6l� _ CO.IMP.NO.
ADDRESS G 1641 JOB NO
CITY EL.N TRUNK PERMIT NO.
REGISTRATION NO. COUNTY ROAD PERMIT NO. C g 3 L
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NOZ Qe.S _PERMIT NO.
BLOCKTRACT pdy y//23.66 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT Dc ?q NO.OF BLDGS. / CHAR S_
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FE
NO. DESCRIPTION OF WOOK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER nS 3.50 RECEIPT NO. GATE BY
HOUSE SEWER CONNECTING T0.
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION ECORDED
W ORK TO HOUSE EWER I:00 _
ALTER OR REPAIR EXISTING NO DA I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 J. CONNECTION DATA
_ TIC TANK,SEEPAE
PITSAND/O R DRAINFGELDT OR 2,00 STATION y / �y� (p
DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 � ///MANHBtE$EFERENCE/.,7
C
GY UPPER� / O&AM&
TYPE OFECTION LENGTH FROM p
OWNERS PERMIT I 00 -� -- e.-t5 M.L.TO P.L. 2 O
AUTHORIZATION ' TOTAL FEE
I HAVE DATEAMED
CON RACTOIR TO CONNECT R THTE ABOVE D ED ES
ABOVWITH THEE E%LASTING APPROVALS INSPECTOR'SSIGNATURE GATE
DWELLING TO THE PUBLIC SEWE 00,
SIGNED THIS..,U.......DAY OF... . __._.___._._19�
NEW HOUSE SEWER rJ�y'6G ,I' `IY� 75'•
OWNER OR L^S' I CON NECTADDITIONAL
OWNERSA NT. ._ ' ""�' "`' _.1 BUILDING OR WORK
/GE SEPTIC TANK,SEEP.PIT(S)
AODRESS..L.:..®�._ .._....k=... __E�...CT�. ,................. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E]
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
I HEREBY CERTIFY ,THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
-- AND/OR LICENSED A R QUIRED BY LOS ANGELES COUNTY ..ABANDON HOUSE SEWER -
AND STATE OF CAL IA OR THAT 1 A TH LEGAL OWN-
ER`OF THE ABOVE RIB
ED ES NT L OP Y. BACKFILL SEPTIC TANKS
SEEP.PIT(S)0 CESSPOOLS
SIGNATURE
OFPERMITTEE.:.._......—. ..:...._....._...... _._........._..................__...
7UA642A 063 7/53 �� 1