HomeMy Public PortalAbout9333 DAINES DR_Sewer__ jDEPARTBEENT OF COUNTY ENG � SEWER—SEWAGE DISPOSAL
' I DIVISION OF BUILDING AND SAFETY i PERMIT APPLICATION!
I COUNTY OF LOS ANGELES. I
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING a
ADDRESSve
FOR APPLICANT TO FILL IN LOCALITY 71 4re .
BUILDING NEAREST
ADDRESS CROSS ST. �
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A •S
CROSS ST. RECEIVED Y 9 Ready for Inspection DATE ISSUED- =
OWNERMAIL (
ADDRESS USE ZONE1 OCCUPANCY MAP .
BI< --Pa-.
CITY TEL.NO.
CONTRACTOR �� p
ADDRES J T� �• •JOB
CITY TEL.N6.O'
7 C° - STATE L �
REGISTRATION N0. / �o �CeO®LINTY ROAD.PERMIT N0.
LEGAL
DESCRIPTION t LOT NO.S • 130 aPd�6 (� &AG T
BLOCK TRACT -1,NDU8f111AL, _
��IROV '
SIZE OF LOT ;( �y NO.OF BLDGS.
KtsAS1 AL
� .✓�/ V NOW ON LOT CHARGES
USE OF
—BUILDINGS /--,� CONNECTION CHAR EIFEE
,NO. . DESCRIPTION; OF, WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 >� RECEIPT NO. 'I DATE I BY
HOUSE SEWER CONNECTING TO 4
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR Y XCEPTIOINIRECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIREXISTING - 0• I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER +r
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR C
PITS AND/OR DRAINFIELD 2.00STATION - DEPTH
CESSPOOL—DRYW ELL ',y
SPECIAL.CONDITIONS ONLY 2.00 I {rv � MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION ' LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.L. Aty
AUTHORIZATION I TOTAL FEE �� ��s t, 72,� 3
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED - Z. Se&il s 2'z*'' ,/ Zowep' I
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE ' DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS---�_--_-. DAY __ ../ -------------19-- NEW HOUSE SEWER �r y.
OWNER OR CONNECT ADDITIONAL "
RK
OWNERS AGENT-.-. _�1 - BUILDI TANKS EP
SEPTIC TANK,SEEP.PIT(S) ,
ADDRESS--_-T --- ---" .............. AND/OR DRAINFIELD
f._;_---- -"
1 HEREBY ACKNOWLEDGE THAT i HAVE AD THIS APPLI- CESSPOOL E3 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 PLUM BING",A-ND`SEWERS. n SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY IWAT I AM PROPERLY REGISTE ED
DISCONNECT PLUG AND.
AND/OR LICENSED A ED THAT I AM THE LEGAL N-
ABANDON HOUSE SEWER
BY LOS ANGELES COU,
AND STATE OF,CA ORNIAEQUI R
ER OF THE ABOVE D SCRIBRESID TIAL PR ER BACKFILL SEPTIC TANKS El
SIGNATU
SEEP.PIT(S)o CESSPOOLS
RE
OF PERMITTEE. ----------
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