HomeMy Public PortalAbout9565 DAINES DR_Sewer__ DEPARTMENT,OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUP'T DF BUILDING ADDRESS ��� - �n�
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FOR APPLICANT TO FILL nIN NEAREST LOCALITY lomBUILDING
/ 7_ � /eADDECROS ST. YOTlfMO'
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LOCALITYteMl�h DISTRICT NO SERIA NO PERMIT NO
ROSS STNEAREST A
2MP`jC8 �° (TV Fi � ►-d 36 5
RECEIVED BY Ready for Inspection DAATE ISSUED
OWNER /0 IJ44& �I;yUS0 V B-C-11 3-5-53
MAIL �S ,�
ADDRESS USEZONE OCCUPANCY I MAP
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CITY F. TE 0 �
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CONTRACTOR *�J CHARGES REIMBURSEMENT FEE
ADDRES��ZZ NO. EIM'` 6 REQUIRED
CITY iTEMPLE CITY NOT REQUIRED
TEL 0
JOB.NO CONNECTION CHARGE FEE
REGISTRATION NO ST '
L"Br CO IMP NO 21j2 2-C-- I _
LEGAL RECEIPT N0. DATEBY
DESCRIPTION LOT NO — I �---
BLOCK TRACT f �,p WAIVER FOR RECORDING
SIZE OF LOT (d Q X ( (,�j NOW ON LOTS RECEIPT NO I DATE I BY
USE OF
ti
NO. DESNGS
CRIPTION OF WORK FEE TRUNK PERMIT NO
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLIC SEWER C9 ; 350 3 5
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 AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 STATION //70. -7 DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00MANHOLE EFE
CESSPOOL—DRYWELL UPPER ��t L�OWER�
SPECIAL CONDITIONS ONLY 200
I —
TYPE OF CONNECTIONLENGTH FROM
Y CURB ✓ PL ML TOPL
OWNERS PERMIT $ I 00
AUTHORIZATION I TOTAL FEE liz
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER ��{[
SIGNED THIS_ SSD- _-DAY OF �7 ---- `-.- -- 19_4_:3, NEW HOUSE SEWER , _Ifs
OWNER OR CONNECT ADDITIONAL
/���J/1� ,` All
, (� ^, BUILDING OR WORK
OWNERS AGENT// J�Vf'1�V(.�1�' -�+� _Ill�l r?�_'C --
ADDRESSIF�10 J b• iii l eg - SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE 7
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS AN ELES COUNT • DISCONNECT PLUG,AND
AND STATE OF CALIFORNIA OR THAT I A LEGAL OW ABANDON HOUSE SEWER
ER OF TH VE S��D E D AL LEGAL
BACKFILL SEPTIC TANKS E]
SEEP PIT(S)� CESSPOOLS
SIGNATURE
OF PERMITTE d_
70A642D 663 12/52