HomeMy Public PortalAbout9331 DAINES DR_Sewer__ ''✓ �3IDEPARTMMNT OF COUNTY ENG�R J '. ii SEWER—SEWAGE DBSPOSAL .'
DIVISION OF BUILDING AND .SAFETY ` PERMIT, APPLICATION
COUNTY OF LOS ANGELES f
WILLIAM J. FOX, COUNTY ENDINEE f it ADDRESSILDING
- FOR APPLICANT .TO 'FILL IN LocauTY '�
BUILDING3 NEAREST
ADDRESS !: CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. r
4 NEAREST A 6 J
CROSS ST. RE EIVED BY Ready for Inspection D TE ISSUED�g.
OWNER ��
--�
MAIL v 'USE ZONE V OCCUPANCY TMAP
\,• ADDRESS
CITY TEL.NO.
w c
CONTRACTOR. � a�' •: ��
ADDRESS' a.-�I;z' 3n'ci / 3 d. �` w�
1_ T JOB.NO: 72 �' s �a
CITY TEL.NIT d - �� ��
_T TRUNK PERMIT NO. "�°�""
STAT E
REGISTRATION N q'CZ 7 / T� ❑COUNTY ROAD PERMIT NO.
DESCRIPTION �le0 +LOT NO. 3CI' ,a7 STATE ENCROACHMENT .
PERMIT NO.
BLOCK TRACT 147,425 INDUSTRIAL
WASTE APPROVAL
y `,36 N0.OF BLDGS. .
SIZE OF'i0T !� NOW ON LOT
/ CHA94S,
USE OF
B �
UILDINGS' CONNECTION CHARG FEE
tu0. 'DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 V RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
-P.RIVATE DISPOSAL SYSTEM 1.00
CONNECT.ADDITIONAL BLDG.OR EXCE TION RECORDED
WORK-TO'HOUSE SEWER 1.00 NO
ALTER ORREPAIR EXISTING I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR.DISPOSAL SYSTEM. - I.00 CONNECTION DATA
T SEPTIC TANK SEEPAGE P17 OR .
' = PITS AND/OR ORAINFiELO 2.00 STATION DEPTH
CESSPOOL"—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER
I TYPE OF CONNECTIONLENGTH FROM
Y.
CURB QP.L. M.L.TO P.L.
OWNERS PERMIT $ I I 00 fX
'AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING , -"APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
' i NEW HOUSE SEWER r
' SIGNED THIS------ ------•---.tAy OF-------------••--•----------•----------.19---••--- �G . JG•OWNER ' OR L
CONNECT,ADDITIONAOV/HERS AGENT ... ::. .
BUILDING OR WORK r'
-- ---- ------ -
SEPTIC TANK,SEEP.PIT(S)
ADDRESS
. -...--- - ; .�,�../'_.. AND/OR DRAINFIELD _..;
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP.LI-. 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 REGIS RED DISCONNECT PLUG AND
AND/OR LICENSED AS,REQUIRED BY'LOS ANGELES ¢l9NTY ABANDON HOUSE SEWER
AND STATE OF CALIF 'ITNIA OR THAT I AM THE LEG L OWN-
ER OF THE ABOVEMSCRIBED R SIDENTIAL PROPE TY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)--CESSPOOLS
OF PERMITTEE- - - .... ....
L. rif----.-.
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