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Home My Public Portal About9332 DAINES DR_Sewer__ :I 7E64 D61 APP��Cn MN FOR F Rn/��T 76A 642D (� ��J If' uvu COUNTY OF LOS ANGELES SEWER—SEWAGE ©OS ®S oWL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING rJ! ! A JOHN A, LAMBIE, County Engineer ADDRESS a fG/ WILLIAM A. JENSEN, Supt of Building_ LOCALITY NEAREST FOR APPLICANT TO FML FML IN CROSS ST LEALDESCRIPTION LOT N0. QO' / rx,S JsD� OWNER MAIL BLOCK TRACT, / `q/ ,�C ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF —BUILDINGS DIST CT NO. GROUP BK MAP PG PROCESS BY � CONTRACTOR - ADDRESS , / jr T CONNECTION DATA CITY A— TEL.NO. Z ®g ION DEPTH / STATE M NHOLE REFERENCE REGISTRATION NO. 15 ® ® COUNTY —00LOWMElf No.�' DESCRIPTION OF WOR -FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM P ITS ANSEPTICT/ORANKAENFIELDIT OR @ $3.00 Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD �- EXTN..CESSPOOL.DRYWELL @ $2.00 aL HOUSE SEWER CONNECTING TOC. NO. Z O PRIVATE DISPOSAL SYSTEM @ $1.00 129=1112=11a JOB N0. V CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER $1.000-0 SEWER OR DIISPOSAL ABANDON YSTEM HOUSE @ $1 0O STATE ENCROACHME t st PERMIT NO. oC. INDUSTRIAL BJ WASTE APPROVAL Cti N CHARGES 7 OlW EWS° PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAYcS DATi INSPECTORS-SIGAPATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19- NEW HOUSE SEWER OWNER ORCONNECT ADDITIONAL OWNERS AGENT -�. BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PITS) AND/OR DRAINFIELD v—Val 1 HEREBY ACKNOWLEDGE THAT t' HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR r yJ PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE 1HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER 4.0 CALIFORNIA OR THAT 1 AM THE LEGAL OWNPL OF THE ABOVE DESCRIBED RESIDENTIAL ROPERTY. BACKFILL SEPTIC TANKS ❑, SIGNATURE SEEP.PIT(S ❑ CESSPOOL _ OF PERMITTEE VALIDATION ROBERT A.A WOOD n CK. 11.0. coax SUPERVISING MECHANICAL ENGINEER �._ L&6.1 7 DEC 15 1 00 6.0 0 TEMPLE CITY 78A@42D `�1Pp��CAT�©N F©Il if PERI1VIl�T CEB°08 8.5 I COUNTY OF LOS ANGELES SENVER—SEWAGE ®US(r` OSAL t DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING „ c JOHN A. LAMBIE; County Engineer ADDRESS 4' CASSATT D. GRIFFIN, Supt of Building LOCALITY ,. _..,: ,,.:�.- . .. ,.., NEAREST 'R OR APPLICANT TO FILL IN CROSS ST. DESCRLEAL GPTI ,57 I LOT NO. / OWNER t MAIL BLOCK TRAC60�p.�g,(�. y4 6p�tcl ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS RICT N0. GROUP MAP PROCESSED - SDIST^T PG• CONTRACTOR ADDRESS �. JJCONNECTION✓DATA l/y r CITY — TEL.NO,y ;n, �p�[ ❑�® � ION S DEPTH 1 REGISTRATION NO. �� ❑ COUNTY `x MANHOLE REFERENCE '.' No. DESCRIPTION O WORK FEE STATE - I. HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION ( LENGTH FROM 2 Y. CURB P.L. M.L.TO P.L. _ , PITS AND/OR DRAINFIELD @ $3.00 - - OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00HOUSE P.C.N0. PRIVATE DVISPOSAL SYSTEM ER CONNECTING TO @ $1.00 C 0. JOB NO._ CONNECT ADDITIONAL BLDG.OR 2 WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT NO - ALTER,.REPAIR OR ABANDON HOUSE �.' STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OVVNER',S° PERMIT ". CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE107 ` REIMBURSEMENT FEE e, 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. i - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALSDATF� INSPECTOR31GN'ATURE TO THE PUBLIC SEWER. " "'S ' SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR - - ° CONNECT ADDITIONAL / OWNERS AGENT BUILDING OR WORK _ ADDRESS - SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD A41) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL. ❑ .h'� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING , ALTER,REPAIR,SEWER OR ?, PLUMBING AND SEWERS. - ALTER,SEWAGREPAIR, DISPOSAL R I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER " CALIFORNIA OR THAT I M THE LEGAL OWNER OF THE ABOVE _ DESCRIBED RESIDENT L PROPERTY. BACKFILL SEPTIC TANKS C1SIGNATURE SEE. PITS) ❑ CESSPOOLS ❑ OF PERMIT EE Al OF VALMATIO - _ ROBERT A. WOOD CIL ILC cAsH SUPERVISING MECHANICAL ENGINEER LA&6,17 3 ;:Z D£C-15 1 1 D . 25.00 m.