HomeMy Public PortalAbout10910 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES - w
WILLIAM J. FDX, COUNTY ENGINEER JI BUILDING
DDRESS,Q�
FOR APPLICANT TO FILL IN LOCALITY
F' _
1 NEAREST l'
CROSSST.
�,t y' DISTRIC�O. SERIAL NO. /IPPERMIITjj NO. C
A tls✓' S
.�.H RqE CSE IqV ED BY Ready for Insoectian 'l DATE ISSUED
USE ZONE OCCUPANCY [ MAP
ADDRESS a BK PG
CITY TEL.NO 9_4�cwqy�D®-� �S r" //D
CONTRACTOR CO.IMP.NO.
AOORESS JOB NO.
C TEL.NO TRUNK PERMIT N0.
REGISTRATION NO. 4'000NTY ROAD PERMIT NO.
LEGAL .STATE ENCROACHMENT
DESCRIPTION LOT N0. ,y PERMIT NO.
BLOCK"13 TRACT�Da� I�� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOTS. CHARGES
NOW ON LOT
USE OF
BUILDINGS C�..�� CONN ECTI 1 CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMEN E
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 .� RECEIPT NO. GATE BY
HOUSE SEWERCONNECTING TO '
P RIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECOR
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR.EXISTING N0. I DATE IBy
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
ANO/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,
,SEEPAGE PIT OR ��..ss l^ t,
PITS AND/OGRAINFIELD 2.00 STATION VZ 1 �� 7 DEPTH 4
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00r MANHOLE REFERENCE }
" � ,U"ER— LOWER'
-TYPE OF CONNECTINy. LENGTH FROM " v
OWNERS PERMIT s 1 00 Y CURB Je P.L. M.L.TO P.L. 2
AUTHORIZATION TOTAL FEE S4
1 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---------_---------DAY OF.................... 19.__.._ NEW HOUSE SEWER
OWNER OR ;`/. ,T BUIILDING ONECT R WORK
OWN ERS AGEN�,f.16$ _
,�..++ ����pp y SEPTIC TANK.SEEP.PIT(S)
ADDRESSO. ..J.�j..ry. ._�,T'T--y..4{�%YX Q. - ANO/OR GRAINFIELD
1HEREBY ACKNOWLEDGE THAT I HAVE READ AIS 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND �.
ANO STATE OF CALIF NIA ORT AT I AM THE AL OWN=
ER OF THE ABOVE CRIBED SIDENTIAL P P RTY. BACKFILL$EPTIC TANKS
SEEP.PIT(S)El CESSPOOLS❑
SIGNATURE
OF PERMITTE .. .._..._._.._.. .._.
76A642A 663 4/53 �� •