Loading...
HomeMy Public PortalAbout10948 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL. DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER + AUILDING DDRESS / /Y tJ ����/fGj 6/,17 FOR APPLICANTr-TO FILL IN LOCALITY BUILDINGj NEAREST / ADDRESS51? CROSS ST. LOCALITY DISTRICT NO. SES 0. PERMIT NO. {dA NEAREST NEAREST. 19JI9'^'..`^- A 6 -[L© (e:�c'S� S RECEIVED BY Ready JorJasoection DATE ISSUED OWNER MAIL 6� i�O J✓4 ADDRESS �. - USE20NE OCCUPANCY I MAP BK PG CITY TEL.NO. CONTRACTOR - ADDRESS ONTRACTOR -ADDRESS JOB.N0. CI Y v cz TELAO. TRUNK PERMIT NO. REGISTR TION NO. El STATE ❑ COUNTY ROAD PERMIT ND. y3(y LEGAL %'`� 9" STATE ENCROACHMENT J DESCRIPTION LOT N0.J Yy ' .��-� PERMIT N0. BLOCK MUSTIAL WASTE APPROV*t� SIZE OF LOTSIqq NO.OF SLOGS. J' /1 NOW ON LOT CHARGES USE OF BUILDINGS CONNECTIONTRARGETEE—.��� NO. DESCRIPTION OF WORK FEE REIMBURSEMENT"FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 4 $ 3.50 �� RECEIPT NO. I DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CO-NNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED WORK TO HOUSE SEWER LDO ALTER OR REPAIR EXISTING � NO-_I DATE I•BY_ SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK.SEEPAGE PIT OR �� �� �y PITS AND/OR ORAINFIELO 2A0 STATION DEPTH CESSPOOL— L SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE `j / /f' GG/ cR' UPPER LOWER TYPE OF CONNECTION LENGTH FROM j Y. CURB P.L. M.L.TO P.L. w.S' OWNERS I PERMIT $ I [I DD AUTHORIZATION TOTAL FEE I - I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIG NATURE DATE DWELLING TO THE PLLBLIC SEWER � -�/ - SIGNED THIS.../ _f_.DAY OF... .. ,.,. _ 19>}3 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT........:.J.'_8.."� .. .. .. BUILDING OR WORK / SEPTIC TANK,SEEP.PIT(S) ADDRESS/a!9.-./ -LL'�$L:C[__._......._.:_.._._._.. ANO/OR GRAINFIELD HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL 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 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 SEPTIC TANKS SEEP.PIT(S)E] CESSPOOLS c 7 SIGNATURE OF PERMITTEE ._. .. ..p .. _...... ._ i6A692D 663 1/53 J'276 • //O