HomeMy Public PortalAbout9304 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
w COUNTY OF LOS ANGELES o6A3 f
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT O FILL IN LOCALITY '
BUILDING P� NEAREST
ADDRESS / _t CROSS ST.
LOCALITY DISTRICT-N0. SERIAL NO. PERMIT NO.
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NEAREST A ��
CROSS SL RECEIVED BYi y Ready for Inspection DATE ISS U b
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OWNER // z,C ,S
MAI ADDRESS / USE ZON,E� OCCUPANCY B
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CITY TELAO.,` & X=
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CONTRACTOR Z C4=
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ADDRESS R JOB.NO.
CITY 24o Z�1— L.NO. r'r TRUNK PERMIT NO.
REGISTRATION N0. �� C0�NTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
TRACT 19 3r.,
IN —
DUSTRIAL
SIZE OF LOT NO.OF BLOBS.
NOW ON LOT CHARGES'
USE OF
BUILDINGS CONNECTION CHARG FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 ( RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RE&RDED
WORK TO HOUSE SEWER 1.00 N0. DATE BY
ALTER OR REPAIR EXISTING j
SEWER OR DISPOSAL SYSTEM 1.00 y a
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR �r
PITS AND/OR DRAINFIELD 2.00 STATION e DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �MLUPPERR ERENC�� OWER
TYPE OF CONNECTI0 LENGTH FROM
OWNERS PERMIT $ I I 00
Y. CURB Pp_-L) M.L.TO P.L.
AUTHORIZATION TOTAL FEE I /V 150 -
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I SPEC OR'SSIGNAT E DATE-
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------_..___.,DA)5 OF!?........_.___......_.....____14_�_. NEW HOUSE SEWER
OWNER OR / CONNECT ADDITIONAL
L � BUILDING OR WORK
OWNERS AGENT------------ ----
SEPTIC TANK,SEEP.PIT(S)
ADDRESS --•-•-----_____-•---------_----------•__.._-----_._._.. -._ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL. DRYWELL El
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIRSEWER OR
REGULATING PLUMBING AND SEWERS. ,SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE.SEWER
ER OF THE ABOVE DESCRIBED RESIDE TIAL PROPE Y BACKFILL SEPTIC TANKS I]
SIGNATURE I SEEP.PIT(S)E] CESSPOOLS F]
OFPERMITTE -------------.................. ....... •------------------•---•
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