HomeMy Public PortalAbout10913 DAINES DR_Sewer__ DEPARTMENT of COUNTY ENGINEEB SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I gOILD I
ORES3 /D 9`y7 G.r. dCJO4�
FOR APPLICANT TO-FILL IN LOCALITY 7-CBUILDING NEAREST
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ADDRESS u�® J j �f CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMITNO. C
NEAREST /
CROSS SA S
T. Q R/�EQ/EI V�sEQ/Bw�/J/ Ready for Inspection DA IS'Zi-13 OWNER � a A b�l // S '��'G.+ l� /� J
MAIL USEZONE1 . 0 PANCY
ADDRESS
BK PG
CITU TEL.NO. //yJ 1.91-1_ ��e //e
CONTRACTOR d/.� //N `p yZy'f 4 CO.IMP.NO. /3
ADDRESS 3' /
JOB.N0.
CITY Fu e x,//`I-e- TEL.NO�L.. / TRUNK PERMIT N0.
REGISTRATION NO. /6 7 7 6 COUATF NTY ROAD PERMIT NO. Z-
LEGALC ^�A / r� STATE ENCROACHMENT
DE��IP'r� _ LOT NO. G. 5O / �k)/B�rl PERMIT NO.
BLOCK TRACTg X / D INDUSTRIAL
n WASTE APPROVAL
SIZE OF LOT �R X 6 SIOW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION CHARGE kEE
,NO. DESCRIPTION OF WORK FEE REIMBURSEMENTFEE
HOUSE SEWER CONNECTING TO
P BLICSEWER @ $ 3.50 .sa RECEIPT NO. I DATE IBY
HOUSE SEWER CONNECTING TO '
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR E) EP T N RECORDED
WORK TO HOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING I ATE BY
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 7 DEPTH
CESSPOOL—DRYWELL t
SPECIAL CONDITIONS ONLY 2.00 p IZOFERENCE a eT li�2/U PP .eLf�h
TYPE 0 CTIO LENGTH FROM
OWNERS PERMIT $ I x�++00 awrcu RB PA. M.L.TO P.L. 7
AUTHORIZATION I TOTAL FEE r7�
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONN T HE ABO DESCRIBED E STING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO T SEWER /
NEW HOUSE SEWER
SIGNED THIS_ ..... ......,DAY .. .___. ..................... 19.. L
CONNECT ADDITIONAL
OWN BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......___........._..._....................................._..._._._.........._. AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL 0 DRYWELL C]
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 I AM PROPERLY REGISTERED
.AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND .
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTICTANKSO
SIGNATURE SEEP.PIT(S)[] CESSPOOLS E -
OFPERMITTEE..........._--___......_.._.._......_.._......_.._..._........._....... _
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