HomeMy Public PortalAbout9427 DAINES DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
WILLIAM J: FOX, COUNTY EN13INEER BUILDING
ADDRESS � _`� I
LOCALITY PP ��
FBUILDINGOR APPLICANTTO FILL I� �9�c�tii� o .6
NEAREST
ADDRESS 49 � (j�0/.�d0 Q CROSS ST.
�� / DISTRICT NO. SER`IA,1'(NO. PERMIT NO.
LOCALITY I A /� �` /
NEAREST p A �46 S
CROSS ST. J
OWNER
RECEIVED BY Ready for Inspection DATEISSUED
MAIL ,ern//1 USE ZONE OCCUPANCY MAP
ADDRESS �� 7 /��[/ BK PG
CITY p'+ TELAO._
CONTRACTOR Lf 5.�'°� �
CO..IMP.NO. !�
ADDRESS, 8,3
JOB NO. -
CITY�'L TEL.NO.k � ',3jq� TRUNK PERMIT NO.
REGISTRATtO N0. ! STATE
ROAD PERMIT NO.
LEGAL �j� 7 STATE ENCROACHMENT
DESCRIPTION LOT N0. / ,,fig A) I,, /�
PERMIT NO.
BLOCK TRACT � � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTN0.OF BLDGS.
NOW ON LOT � CHARGES
USOF
BUE DINGS ` QJt ` CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE �
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @'$ 3.50 RECEIPT NO. �6ATE I 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- I/
'DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION-DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION � �� m.. . DEPTH' +'
CESSPOOL—DRYWELL _
SPECIAL CONDITIONS ONLY 2.00 ®J P/ JAN�IHOOLEE REFERENCE ;10 ER-�, ;
TYPE OF CONNECTION LENGTH FROM -
OWNERS PERMIT $ 1 00 �Yc� `CURB.' -P L•. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 4 150
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING- APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
C'.) � r
SIGNED THIS�t_..'/�----QDAY OF-/J 5t- I NEW HOUSE SEWER
i r CONNECT ADDITIONAL
OWNER OR �,1 �� BUILDING OR WORK
OWNERS AGEf�'�.�. ---..- ---� }�--�•--
ADORESS- --]. �� �"°�7!.- e� f---... -: AND/OR DRASEPTIC INF ELD IT(S)
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDEIWTIAL PROPE TY. BACKFILL SEPTIC TANKS R
�� SEEP.PIT(S)Cj CESSPOOLS
SIGNATURE
OF PERMITTEE---
76A642D 663 1/53 _ I /'
01
CES08 10-62
76A6420 APPLICATION
TION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETYkDIVISION BUILDING !
JOHN A. LAMBIE, County ADDRESS
WILLIAM A. JENSEN, SuptLOCALITYNEAREST
FOR APPLICANT TOCRDBS ST.;;
LEGAL `DESCRIPTIONLOT NO. ��0 �+ _ OWNER
MAIL
BLOCK TRACT V ADDRESS
NO. OF SLOGS.
SIZE OF LOT NTDW ON LOT CITY TEL. NO.
j�B
SE OF DISTRICT NO. GROUP MAP PRO
USE
UILDINGSj)BK PG If
ONTRACT R
ADD s CONNECTIO DATA
C Y TEL. O STATION �d DEPTH
�y STATE MANHOLE REFERENCE
REGISTRATION NO dre� ElCOUNTY 3()r23r LOWER a
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH F OM O
HOUSE SEWER CONNECTING TO Y. CURB P.L. M:L.TO P. . V
PUBLIC SEWER @ $5.00
P.C.NO.
SEPTIC TANK,SEEPAGE PIT OrR
CO.IMP. NO. JOB NO. O
PITS AND/OR DRAINFIELD @ $10.00 �
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (�
PRIVATE DISPOSAL SYSTEM @ $3.00 {jJ
CONNECT ADDITIONAL w� AFFIDAVIT wglvE1 EASEMENT RECORD. INST-.NO. DATE H
WORK TO HOUSE SEWER @ $3.00 1 +y
OVERFLOW SEEPAGE PIT,DRAINFIELD - L -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
'
OWNERS PERMIT $ 2 00
AUTHORIZATION TOTAL FEE oI SL CONNECTION CHARGE FEE CHARG S
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE . . ". APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY,O 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGE J CONNECT ADDITIONAL / _� r
BUILDING OR WORK
.ADDRESS
SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE' IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I. AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTE D TO DISCONNECT PLUG AND
RESIDE IN, THE A E DESCR ED-R IDENTI Y. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITT SEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
Li'1uD 55 3 9 5 FEE 1_ 0 1 0 D 5,00-
�'