HomeMy Public PortalAbout9318 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 ENDINEER BUILDING
ADDRESS
FOR APPLIG NT TO FILL IN LOCALITY rx'"/' V
BUILDING NEARESTJ
ADDRESS ��� o � •° CROSS ST. -
LOCALITY { DISTRIC NO. SERIAL NO. PERMIT NO.
NEAREST g .� ` ' �.+ J� lr/ f6
CROSS ST. x,-
U, RECEI ED BY Ready for Inspection DATE ISSUED_
OWNER
MAILgq �/ 1
ADDRESS' ., _(a } x9., a -, ll USE ZONE ;PUPANCY
BK MAP PG
CITY TE L.NO �
CONTRACTOR !; CO.IMP.NO.
ADDRESS � .� 'fid .9 �i@ ,� �y�
Crd�` JOB.N0.
CITY ria _.TEL.NO. �y�'�� TRUNK PERMIT NO.
REGISTRATION NO. /. • IVA- lqiI-COUIWT•*i ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. t;� (/ (,j I STATE ENCROACHMENT
/�� '•� PERMIT NO.
�
BLOCK j/RACT V / � v INDUSTRIAL
rr WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. �f
NOW ON LOT fr CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
r REIMBURSEMENT FEE '
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.60 RECEIPT N0. DATE BY
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. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER i
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA _
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL-DRYWELL � �� /�`
_SPECIAL CONDITIONS ONLY 2.00 IpMA UPPERREFERENCE E /�3q ER`
LON
TYPE OF CONNECTION LENGTH FRO u7 P
OWNERS PERMIT $ ( - I 00 t
V'. CURB P.L. M.L.TO P.L. dig
AUTHORIZATION ( TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED.
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGI APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER y
SIGNED THIS - DAY OF 19- 1
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----------__-------------------_--- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----------------_----- - - - ------• AND/OR GRAINFIELD
! 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'- DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1-AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)� CESSPOOLS
-
OF PERMITTEE--
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