HomeMy Public PortalAbout9314 DAINES DR_Sewer__ I DEPARTMENT OF COUlITY ENGERTEM SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF HAS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANTLOCALITY
tTO FILL IN
BUILDING [w a/L/ Fa ^ NEAREST .�
-ADDRESS. (•=J G. +l��r CROSS ST.
'•LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST,
RECEIVVEDD BY Ready for Inspectlen DATEISSUED
OWNER
MAIL USE ZONE OCCUR NCY MAP
ADDRESS ® ® 3"C] 1 ®
BK PG
CITY TEL.NO. 7 '�2sgl
CONTRACTOR( Fes^
y� tJ CO.IMP.NO.
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ADDRESS ���Oa ' , JOB.N0. jo�:J
CITY TEL.NO�P iV ; TRUNK PERMIT NO.
ST
REGISTRATION N0. / l '3�G qg� 3 e�-^, —(��f (1j:CO,�tI[JMYY ROAD PERMIT NO.
LEGDESCRIPTION LO+T'NO. 6AJ Ij �/ ',-( G�t�J" y� / STATE ENCROACHMENT
�
�� PERMIT NO.
BLOCK. TRACT �� �f� `o��"," �] INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOTS CHARGES
USE OF
Z�
BUILDINGS �j j� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 W RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.Oft EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO ( 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
PITS AND/ORDRAINFIELD 2.00 STATION �.DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 /' � MANHOLE REFERENCE
y UPPER /--- L-OW£i(`•
TYPE OF CONNECTION LENGTH FROM q L i-
OWNERS PERMIT I 00 X—,�CUR4 P.L. M.L.TO P.L.
'AUTHORIZATION I TOTAL FEE
CONTRACTORHAVE
TO CONNECT THATE E AED BOVE D SCRIBEDWITH THE I EXISTING TING NAMED APPROVALS ' INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF------------------ ---------------.19-- NEW HOUSE SEWER
'OWNER OR
CONNECT ADDITIONAL .OWNERS AGENT................................-....................................._....---- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS --------------------------..` AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ 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
_ 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 SEPTIC TANKS❑
SIGNATURE �.��� � SEEP.PIT(S)[3 CESSPOOLS E
OF PERMITTEE-. '"�'`+ -- _
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