HomeMy Public PortalAbout9451 DAINES DR_Sewer__ U'— a lL.-el G --4.4 �tJ =G
DEPARTMENT OF COUNTS nvEE<t SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS 9ga �d �! 1r.
CA55ATT D. GRIFFIN,-Sua•r of BUILDING
FOBUILDING +�R�t�A9ePPLIC(A�NT.TO FILL IN LOCALITY A
NEAREST
ADDRESS !,'f.b! �r p - .�JC�+���► CJ�'d' CROSS ST. 0-_S Ci ® d/ C Y'
s LOCALITY �� DISTRICT NO. SERIAL N0. PE IT N0.
..NFA R1 ST
1. CROSS,T C�Lv-L
- -RE EIV BY Ready 1'or Inspection q DATE/ISSUCED
id^ OWNER
MAIL USE ZONE 'r OCCUPANCY MAP
ADDRESS BK PG
CITY Af
TEL.NO.IV
�
CONTRACTOR, �, � (�� CHARIVS REIMBURSEMENT FEE
ADDRESS e) CJs^' REQUIRED
® NOT REQUIRED
":CITY � TEL.NO.,frL/f3l .. CONNECTION CHARGE FEE
JOB.NO.
REGISTRATION NO. C•h/d' ���ri3! STATE
CO. MP. NO? `
LEGAL ✓r aw u �' e , RECEIPTNO. I- DATE LBY— -
DESCRIPTION LOT NO.
BLOCK TRACT � , .�A'.4 WAIVER FOR RECORDING
NO.OF.BLDGS. p� I �DATE""o°�' LgX,__._� .
SIZE OF LOT J'0 �/��® NOW ON LOT oL, RECEIPT NQ.
USE OF
BUILDINGS_ J-? o• Yr�.t*AA�
TRUNK PERMIT NO. -
-`
NO. DESCRIPTIpN OF WORK JEE
HOUSE SEWER CONNECTING T0- ROA'D'PERMIT NO.
PUBLICSEWER @ $ 3.50 e 12 1 /7
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR.EXISTING'
SEWER OR DISPOSAL SYSTEM . 1.00 CONNECTION DATA
DISCONNECT ANDABANDON SEWER
AND/OR DISPOSAL-SYSTEM' 1.00 STATIONDEPTH 4�
SEPTIC TANK,SEEPAGE PIT-OR ..
PITS AND/OR DRAINFtELD_ 2.00 MANHOLE y J
CESSPOOL—DRY.WELLP UP LOWER 97,5- 1,41
SPECIAL CONDITIONS ONLY.' ' 2.00 I Ii
TYPE OF CONNECTION LENGTH FROM ?
• -.. CURB __ __ .M.L:TO P.L. .7
OWNERS PERMIT $ I•, 00
AUTHORIZATION. TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE-ABOVE DESCRIBED EXISTING, APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH�PUBLIC SEWER: ' k
SIGN EI THIS -----DAY OF-----f - -'���----------.. I9S5- NEW HOUSE SEWER ,/LO/iR , I PvG
OWNER OR /A -'`- CONNECT ADDITIONAL r
OWNERS AGENT... -.----- -- -- - ---- --------_---- .------_ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-..------� ? - - ----------------- - AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPL-I- CESSPOOL D DRYWELL
CATION AND STATE THAT THE ABOVE IS RRECT AND AGREE
TO COPdPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND-SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED--BY LOSeANGELES COUNTY DISCONNECTUSE
AND STATE OF CALIFORNIA OR THAT I-AM THE LEGAL' OWN-
ER OF THE ROVE, 'E C BEQ SIDENTI PROPERTY. BACKFILL SEPTIC TANKS
�/ SEEPIPIT(S)E] CESSPOOLS
❑
SIGNATURE ' eQ',
OF PERMITTEE 1 .......... ---- ----- - -- ------
76a642D 663 12/52 - ,