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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- �'