HomeMy Public PortalAbout10851,10850 DAINES DR_Sewer__ DEPAILTMENT OF COUNTY ENOINEM SEWER-SEWAGE DISPOSAL ¶
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF OF LOS ANGELES BUILDING @
'. . WILLIAM J. FDX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT TO FI;LL LOCALITY
BUILDING "/ � NEAREST /�ADDRESS C/r / //Y' O CROSS ST. 1 }�LOCALITY Jl JPDISTRICT NO. SERIAL NO. 1PEERMIT NO.
NEAREST
ROSS ST. LL�-� RECEIVED BY Reatly far InsOection DATEISSUED
OWNER _C.rti-� jkMAIL11 lir; J USEZONE OCCUPANCY MAPADDRESS ti.r
BK PG
CITY ..e_/ TEL.NO.
CONTRACTOR `'II�L,�(.(i�
CO.IMP.N0. !"
ADDRESS j �, }T"J' JOB NO.
CITY -,�( � TELAO.u(/n I 7 TRUNK PERMIT NO.
REGISTRATION NO. �J� y F.f-� STATE ^
COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. � . N STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT /L `60 ' INDUSTRIAL
WASTE APPROVAL I
// NOWOOF LLDTGS.512E OF LOT NONJJ
CHARGES
USEOF424
1 /
BUILDINGS I/4/)c lY��f �]y�_ ' CONNEC IN CHARGE FEE /
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE— /
HOUSE SEWER CONNECTING TO
PUBLCSEWER0 $ 3.50 \Za RECEIPT NO. DAT\ IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I DATE IBV
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/011 DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION ,�..i.Q I DEPTH
CESSPOOL—DRYWELL
57
SPECIAL CONDITIONS ONLY 2.00 F.rj MANHOLE REFERENCE
1Li wn n-1 -d"xB' -COWER
TYPE OF COLENGTH FROM
OWNERS PERMIT S 1 DO Y. _CUFNNECTION�R:G M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 14
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABO E DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER r
SIGNED THIS_.:z5 ------- AY OF...... -- ------------_----- 19_'.L NEW HOUSE SEWER ?- -
CONECT
OWNERS AGENTOWNER OR ._. "�� BUNLDING ORDW ORKAL
......_.. .._. w _......_.._..._......._
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.'.., 4�---- -- _._ L . ........_.........._.............. AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CA
TIONAND 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LIC ENSEO_ 8 REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALI O NIA OR THAT i AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE CRIBED RESIDENTIAL ROPERTY. •BACKFILL SEPTIC TANKS[]
9 SEEP.PIT(S)[] CESSPOOLS[]
SIGNATURE
OF PERMITTEE..._..... _. ..._x:1.... . 7.. _�...r.
76A642A 663 7/53 A