HomeMy Public PortalAbout9412 DAINES DR_Sewer__ 24650 INSERTS
768066,60
7sAya2o /(]�
PP11 O1( _!ff'��ll TO N FOR PERMOT •• .
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER �����—��.. ., `•a _.
BUILDING AND SAFETY DIVISION BUILDING
-ADDRESS �c
JOHN A. LAMBIE, County Engineer /
WILLIAM A. JENSEN, Supt of Building LOCALITY 'e
,, F .�,,, �,....;.o .,.•.. .... -
NEAREST -
FORAPPLICANT TO FILL IN' CROSS ST.
LEGAL 701 �,
DESCRIPTION OWNER
NO.
BLOCK TRACT
K[ ' .MAIL S���rti.
// LQ 1 ADDRESS '
NO.OF SLOGS.
SIZE OF LOTj,2 NOW ON LOT CITY TEL NO.
USE OF
BUILDINGS DISTRICT NO. GROUP BK MAP I'P.. D PROCES BY CONTRACTOR & — I
J
a ADDRESS •W/ 2� C r "'��� CONNECTION DATA
a• iglCITY TEL. 0. 3t� fi TION DEPTH.
REGISTRATION NO. ]r �� 5 / COUNTY C- MANHOLE REFERENCE ,.^5' UPP
NO. DESCRIPTION OF WORK FEE
K HOUSE SEWER CONNECTING TO
PUBLIC SEWER CO) $ .00 TYPE OF CONNECTION LENGTH FROM '
SEPTIC TANK,SEEPAGE PIT OR Y. CURB .L. ' M.L.TO P.L.
PITS AND/OR DRAINFIELD @ 4.00
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN..CESSPOOL. DRYWELL @ 2.00
HOUSE SEWER CONNECTING TO N0.
PRIVATE DISPOSAL SYSTEM @ 1.00 " CO. IMP. NO. JOB NO. p.
CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT N0. ROAD PERMIT NO. L72 7 V
WORK TO HOUSE SEWER @ 1.00
SEWER OR DISPOSAL SYSTEM HOUSE @ $i OO STATE ENCROACHMENT 14
PERMIT N0. O
INDUSTRIAL V
WASTE APPROVAL W
!' CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE T r REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING'DWELLING APPROVALS DAT INSPECTOR'S SIGNATURE
TO THE PUBLIC SE p 2 A"v.
SIGNED THIS DAY OF 19� NEW HOUSE SEWER' q 6I+flr -�ii` �
OWNER OR /� CONNECT ADDITIONAL
OWNERS AGENT_/C(s V' BUILDING OR WORK a
SEPTIC TANK,SEEP.PITS)
!. ADDRESS AND/OR DRAINFIELD
I .HEREBY ACKNOWLEDGE THAT_ I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [:1 DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR _
PLUMBING AND SEWERS.' SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AAANGELES
RE TERED AND/OR DISCONNECT PLUG AND
e LICENSED AS REQUIRED BY LOSU AND STATE F : - ABANDON-HOUSE SEWER - -
CALIFORNIA OR TH R OF THE E
ESCRIBED RESID 1 BAC ILL SEPTIC TANKS El• .SE PIT(S) ❑ CESSPOOLS ❑
SIGNATURE
OF PERMIT 131-2.2,
OF LIDATION ROBERT A. WOOD
M.o. CASH SUPERVISING MECHANICAL ENGINEER
LM0 g 3 O 1Q; JUL 9 1 o o 7.00-
ell
l/v
p 1 a 24650 .IN RTS
.60
76)C'642D
COUNTY OF LOS ANGELES SEWER-SEWAGE. DOSPOSAL
DEPARTMENT OF COUNTY ENGINEER
TDRESS
GBUILDING AND SAFETY DIVISION Engineer A
WILLIAM AOHN .JJENSEN, Supt of Bilding 1001.FOR APPLICANT TO FILL IN .
LEGALOWNER.
DESCRIPTION LOT0.
MAIL
BLOCK
BLOCK TRACT / ADDRESS
' .r SZ G .RO.OF BLDGS. °.
SIZE OF LOT A, ' ' S NOW ON LOT CITY TEL. NO.
USE OF DISTRICT N0, GROUP MAP PROCES D BY
BUILDINGS (QJ/ BK PG I /
CONTRACTOR /,? ,e ,L, eO Af fk.
ADDRESS CONNECTION DATA
CITY gyp /V k fTEL.N0. 6 ION DEPTH
6 ^� C ANHOL
ATE 3 E REFERENCE •"'UPPER
•' REGISTRATION NO. // eif s / T COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
gPUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROMEPTIC TANK,
ITS AND/OR DRAENFGELDT OR @ $3.00 Y. CURB P.L. M.L.TO P.L. C/
OVERFLOW SEEPAGE PIT, DRAINFIELD �
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. N0. JOB NO, p,
CONNECT ADDITIONAL BLDG.OR WORK TO TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. V
ALTER,REPAIR R ABANDON SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT FA
SEWER ' PERMIT NO. O
INDUSTRIAL .V
N. WASTE APPROVAL a
CHARGES D7
O ERS PERMIT $ _ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING -DWELLING APPROVALS D TE f INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW .j..
SIGNED THIS—DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT -BUILDING OR WORK - - -
SEPTIC TANK,SEEP.PIT(S)
u ADDRESS ` AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 'HAVE READ THIS APPLICATION •• s- - _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �. CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING o. ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY R I ERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO TY AND STATE OF ABANDON HOUSE SEWER
'x CALIFORNIA OR THAT--\1 AM T E LEGAL OW E OF THE A VE BACKFILL SEPTIC TANKS El>; DESCRIBED RESIDE IA P 0 Y.
5 P.PITS) ❑ CESSP ❑
SIGNATURE
OF PERMITTE
OF ALIDATION ROBERT A. WOO
c Al.0. CASH SUPERVISING MECHANICAL ENGINEER ".
13021 JM 9 1 .D 25°00- � .. ..