HomeMy Public PortalAbout10952 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 I BUILDING /�
ADDRESS O �pZ A ,Olt.
FOR APPLICANT TO JILL IN LOCALITY Tg4gL c CiTy
UILDING NEAREST
BOGGESS /CI�/-5.� ._l/�Jii?E'J �/'- CROSS ST.
DISTRICT NO. Ready for Inspection PERMIT NO.
NEAREST S
CROSS ST.
�' RECEIVED BY DATE ISSUED BY DATE
OWNER ��/ 7^ C C% /l�/'�
ADDRESS ✓�/J9� USE 20NE I f
DOCCUPANCY MAP
BK PB
CITY TELNO.
CONTRACTOR_ •G��..��/7/ ��jJ/ .i'%:O/7 CO.IMP.N0.
ADDRESS—,rte 10:�;' JOB.NO.
TEL.NO. TRUNK PERMIT NO.STATE
p /
REGISTRATION N0. /�J `J �Qrf ®'COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
POR p PERMIT NO.
BLOCK TRACT �0�9�' INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT I" X 7,5' NO.NOW OF BLOTS. / CHARGES
NON LOT
USE OF y�
BUILDINGS /S��f/l/f-'fJj'/� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
LHOUSE SEWER CONNECTING TO
PU BLIC SEWER a 1 8.50 RECEIPT NO. I DATE IBY
.HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00' _
ALTER OR REPAIR EXISTING NO. I DATE IBY
_ SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ ANO/Olt DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR C
Sf7
PITS AND OR GRAINFIELD 2.00 STATION �•G DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 4/' ja"kv MANHOLE
REFERENCEUPPER
_ r•• TYPE OF CONNECTION LENGTH FROM (70D
�
OWNERS PERMIT s 1 OC CURB M.L.TO P.L.
AUTHORIZATION TOTAL FEE ; /
I 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 0 _. ��/ __I NEW HOUSE SEWER
OWNER OR � f/F /• CONNECT ADDITIONAL
OWNERS AGEN� L.:_L�l,/ /}� � ._. _.._ BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS..............._.._.._......__......_..__._._._..----------------._.._......_... AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL Q 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. I SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
ABANDON HOUSEBAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ASIG
BOVE/OESCMBED RESTOENTI PROPERTY. BACKFILL SEPTIC TANKS
�/ SEEP.PIT(S)� CESSPOOLS tea'•
OF PERMITTEE..." J'Y'.(�. L:: - fes _..
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