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HomeMy Public PortalAbout9927 DAINES DR_Sewer__ r)EPARTMENT OF COUNTY-ENGINEER 'SEWER-SEWAGE DISPOSAL 'DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES Ey WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRESS � V FOR T TO FILL IN LOCALITY BUILDING Z �J i7 NEAREST— T. _n ADDRESS ��/ CROSS S 'C LOCALITY �� ��� DISTRICT NO SERIAL N0. pP�•E.�RMPIT N0. NEA S ST��� _/4 V-fy 4/�I. A U S CROSS ST, y lam` ECEIVED BY Ready for Inspection DATE ISSUED OWNER / Gvlo� _C�- E3 MAIL USE ZONEOCCUPANCY MAP -ADDRESS �'j� // �✓ BK PG CITY1ZO AZMELAO. p CONTRACTOR / ��f ®�.y. � CO.IMP.NO. ADDRESS ©�/al�d �ry� a? -7 JOB.NO. CITYTEL.NO. &,,/ 4 / TRUNK PERMIT NO S 101' .47 rPrTATE REGISTRATION NO. COUNTY ROAD PERMIT NO. ��rsy0 LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. �j p� PERMIT NO. BLOCK TRACT -3J O ✓ INDUSTRIALWASTE APPROVAL SIZE OF LOT NOW ON LOTS .22 CHARGES USE OF BUILDINGS [�,(/�� r� CONNECTIO ARGEFEE NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE ! PUBLIC SEWER a $ 3.50 C �� RECEIPT NO. dl E IBY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER (.00 ALTER OR REPAIR EXISTING NO' I DATE 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 DRAINFI LD 2.00 STATION -� DEPTH CESSPOOL—DRYWELL _ SPECIAL CONDITIONS ONLY 200 1 MANHOLE REFERENCE err '"Re"A LOW E TYPE OF_CO,NNECTION LENGTH FROM r� OWNERS PERMIT $ I 1 00 �-� - M.L.TO P.L. w7® AUTHORIZATION TOTAL FEE CONTRACTOR TO CONNECT THEHAVE ED ABOVE DESCRIBED IEXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE UBLIC SEWED�� SIGNED THIS..__ _. _.DAY OF_ ;!! _ 19 'J NEW HOUSE SEWER ��,�� JA 7C / CONNECT ADDITIONAL _ OWNER ORERS AGENT. ,_`..� !1 �d � BUILDING OR WORK �.._ �ff/ SEPTIC TANK,SEEP.PITS) ADDRESS___ _.._. ..��_��!��?_.1:�_.._ ........__....__.. AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I 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 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT i M THE LEGAL OWN- -ABANDON HOUSE SEWER ER OF THE ABOVE DE8 RIBED RES NTIAL P OPERTY. BACKFILL SEPTIC TANKS� SIGNATURE /�'��r�� SEEP.PIT(S)� CESSPOOLS G OF PERMITTEE.. _��._.*._ ___..._..�� !C..� 76AG42A 663 7/53 ��