HomeMy Public PortalAbout10836 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGDVF.LIB SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 1 08CJ kJ BUILDING 1BG3LIrl$ t"'
FOR APPLICANT 7/��) FILL lk j/�/ LOCAurY-� e- mr,Ie- Cf u
BUILDING
ADDRESS�D tIG.J eL!��ifnA `� NEAREST
CROSS ST. Q - Ave-
LOCALITY /J DISTRICT NO. SERIAL N0. PE RMIT NO.
NEAREST E /Li/J /� A
CROSS ST
.RECEIVED BY Ready for InlDDot_lon � DATE ISSUED
OWNER Y, — aecler
MAIL USEZONE OCCUPANCY, BK MAP.
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CITY TE L.NO- A J/ V • //- � f
CONTRACTOR
ADDRESS DyJOB.NO.
TRUNK PERMIT N0.
❑ STATE
REGISTR ION N0. ^^�� �yy� __/� ❑ COUNTY ROAD PERMIT NO.
DESCRIIPTIO/9LOTNU/(�^/O.3 Y 'SAW JV/ I STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT r/ (� ~� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT7� L ,X 7 NO.OF BLDGS. CHARGES
GES
NOW ON LOT '
UREOF
BUILDINGS /%uP/j/1i4 CONNEC (CHARGE FEE
NO. DESCRIPTION OF W❑ K FEE REIMBURSEMENT F
HOUSE SEWER CONNECTING TO - _
PUBLIC SEWER @ $ 3.50 C RECEIPT NO. ATE I BY
HOUSE SEWER CONNECTING TO -
PRIVATEDISPOSALSYSTEM 1.00
CONNECT ADDITIONAL SLOG.OR EXCEPTION RECORD
WONI(TO HOUSE SEWER - - 1.00
ALTEROR REPAIR EXISTING NO- I DATE B
SEVER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABA NOON SEWER
AND/UR DISPOSAL SYSTEM 1.00 CONNECTION DATA -
SEPTICTANK,SEEPAGEPITOR /
PITS AND/OR GRAINFIELD 2.00 rA7TI ]N -9 f 20,d DEPTHCESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY �O/MA PP EFERENCE £8
F ECTION LENGTHFROMOWNERS PERMIT $ I DDURB �. M.L.TO P.L. dS
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS -INSPECTOR'S SIGNATURE DATE "
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..-3/.....-.DAY OF_,.�P�G.-_. ._-____--19------- NEW HOUSE SEWER -
OWNER 'OR _- CONNECT ADDITIONAL '
OWNERS AGENT-.. .. ..'- .-:.
BUILDING ORWORK
/, / .L...--... ...- /p -.c
ADDRESS PIC Q..l.-V'.._-.-..>___-. _Q! ✓�rE.c?..__1-1L1.t/-._.-.... AND/OR GRAINFIELD IT(5) .. .. _
CANEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL I]
N 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 I 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 WIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)Q CESSPOOLS -
OF PERM ITTE
76A642D 663 1/53 j
OK/1 I/
f _ -