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HomeMy Public PortalAbout9803 DAINES DR_Sewer__ 642D 2/70 76A APPLICATION FOR PERMIT 76A 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, COUNTY ENGINEER' ADDRESS Q IC, o COLEMAN W JENKINS SUP T OF BUILDING LOCALITY NEAREST C © F+ F R APPLICANT TO FILL IN cRoss sr (PRINT OR TYPE ONLY) LEGAL R DESCRIPTION LOT NO OWNER �I^ MAIL 7� BLOCK TRACT1-3 ADDRESS NO OF BLDGS �-7 SIZE OF LOT NOW ON LOT Z 0 CITY TEL NO LL USE OF BUILDINGS J /' !a/s [)ISTR NO GROUP ('LA 55 KMPG AP PROCESSED BY 1� BS CONTRACTOR L-"tZ♦ Jq/-K-/ -j `-// - © ,r ADDRESS ", G,/r,/�l/.,Sfr./ gJ.� CONNECTION DATA CITY All TEL NO ,r Y// STATION DEPTH STATE L UPPER LICIC ENSE NO 262 GLA 85 MANHOLE REFERENCE 7 LOWER NO I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER $5 00 PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD $10 00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO a PRIVATE DISPOSAL SYSTEM 3300 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER 1411MINT RECORD INSTR NO DATE U WORK TO HOUSE SEWER @ S3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 - O ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING F SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHM 7 V PERMIT NO W CL INDUSTRIAL N WASTE APPROVAL Z OWNERS PERMIT E Oo CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE 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 SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK j �dGi 7'•" SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABje DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE 167 BACKFILL SEPTIC TANKS ❑ SEEP PITfS) ❑ CESSPOOLS ❑ VALIDATION JACK R. ALLEN cK M o CASH SUPERVISING MECHANICAL ENGINEER L C0 5 �:1 .7 5 "- APR 4 1 0 D 6,Q 0 2"° 76A 642D APPLICATION FOR PERMIT 76A 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST G /�E-S S JOHN A LAMBIE. COUNTY ENGINEER G /� COLEMAN W JENKINS SUPT OF BUILDING �� L lr� Y FOR APPLICANT TO FILL IN(PRINT OR TYPE ONLY) 7 16 ,��J17(- ,� i-) C.�J GS 7- LEGAL (PRINT LOT NO OWNER /G /( ¢ MAIL BLOCK TRACT O, ADDRESSNO ,p (� 7 SIZE OF LOT NOWOON LOTS CITY Tel r L�`�J/—,/EL NO (J I O USE OF _/ DISTRICT CLASS MAPVROCESSED BY BUILDIT NGROUP NGS �" GB PG CONTRACTOR �9'L ILI�IJv tS 'S G' � ADDRESS ,, �/� TV JJ /1 CONNECTION DATA. CITY /JS /7Oi7 TEL NO L, J Sli /y� STATION O!/ DEPTH STATE 3 �6LIC C ASS UPPER G MANHOLE REFERENCE /"� I l I E LICENSE NO l/ �J NO DESCRIPTION OF WORK FEE TYPE OF CO TION LENGTH FROM HOUSE SEWER CONNECTING TO Y ('CURB j P L M L TOP L PUBLIC SEWER $S 00 SEPTIC TANK SEEPAGE PIT OR �J / PC NO PITS AND/OR DRAINFIELD Q $10 00 CO IMP NO /Gi �([� JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ $300 (� OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE $5 0009 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING O 0 SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT V PERMIT NO W INDUSTRIAL a WASTE APPROVAL Z OWNERS PERMIT $ 00 CHARGES AUTHORIZATION1 TOTAL FEE Q CONNECTION CHARGE FEE IHAVE AT'THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE R yam/ -7 APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS AY OF / JZGI�' I �" OWNER OR NEW HOUSE SEWER 3�� t OWNERS AGENT .( CONNECT ADDITIONAL ADDRESS �C E "711)p9✓I'tAj J BUILDING OR WORK SEPTIC TANKSEEP PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRI RESIDENTIAL PRO TY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE - BACKFILL S S`Ma'VftWr4�j CESSPOOLS y> JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER 0!�ATION CASH L ri '► 2 A, ? APR j 1 D 1 0.0 0 uIL)0