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HomeMy Public PortalAbout10843 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENOLNEER Z � � v DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL COUNTY OF LOS ANGELES' PERMIT APPLIBUILDINGCATION WILLIAM J. FOX, COUNTY ENGINEER I AODRESS zDR 413. !,_, • D19/sVES,D'Ao FOR APPPLLI3CAN TO�q FILL IN �IyN(( /� /{J LOCALITY T- EST BUILDING �}•—©� • J �"'n/aY-c f.� /�fJ/(G, CRONEASS ST. LOCALITY // / -.� DIST�.. SERIAL NO. PERMIT N0: NEAREST A CROSSST }p R 1 Ready for lnnpeellon D YEISSUED OWNER /J✓,&MAIL �J-��� Xl- 112-615-41 1 ADDRESS / V'VT_j jDAhe l/ 46ff Ilk USE ZO E OCCUPANCY �' BK MAP PG CITY TELNO. CONTRACTOR m4�' [ �) CO.IMP.NO. ADDRESS S7- ""B(�/TI `^`� JOB.NO. CITYl/¢TEL.NO. . -TRUNK PERMIT NO. .�(,� REGISTRATION NO. TATE F / COUNTY ROAD PERMIT N31L-LLEGAL DESCRIPTION LOT N07 �r/� / "TATE ENCROACHMENT PERMIT NO. BLOCK TRACT �j� ® INDUSTRIAL ./ WASTE APPROVAL f, Ir NOW ON LOTS _ SIZE OF LOT CHARGES USE OF YM(T BUILDINGS _ 'EE NO. DESCR TION OF WD FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO - PUBLICSEWER G $ 3.50 RECEIPTN 'ATE BY HOUSE SEWER CONNECTING TO 3-a -S4 '�a PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 _ RO. ALTER OR REPAIR EXISTING 8=_ SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR GRAINFIELD 2.00 STATION DEPTH CESSPOOL-DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER' LOWER TYPE OF CONNECTION LENGTH FROM / Y. CURB P.L. M.L.TO P.L. SAS OWNERS PERMIT S I 00 AUTHORIZATION I TOTAL FEE CON CONTRHAVE ACTOR TO CONNECT THS DATE E ABOVE DESCRIBED EXD WITH THE HEREIN ISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO T E PUBLIC SEWE SIGNED'THIS. -' ....DAY-OF --_.I NEWHOUSE SEWER, OWNER OR /� CONNECT ADDITIONAL OWNERS AGENT L yp� BUILDING OR WORK SEPTIC ADDRESS...J..�:A--. .. ._....... .._ .�.._.._._...._. AND/OR GRAINFIELD PIT(S) :_ yZp1{Fp q _ _.. Z(R-�^�.._ ........._. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLL CESSPOOL 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. I SEWAGE DISPOSAL SYSTEM I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND / AND%OR LICENSE S REQUIRED BY LOS ANGELES COUNTY AND STATE OF F IRNI R THAT I A THE'LEGAL OWN- ABANDON HOUSE SEWER ER OF THE,AB ESCRI S N L P ERT BACKFILL SEPTIC TANKS SEEP.PIT(S)Fl CESSPOOL$0 SIGNATURE OFPERMITTEE.......__._.._...._.._....___......_.........._....:............._...... 76AG42A 663 7/53 �,,.. �- QI kK,