HomeMy Public PortalAbout9968 DAINES DR_Sewer__ °
k&E-663 ' APPLICATION FOR P RMI 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department,of CountyEagineer
County of Los Angele8 BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR-APPLICANT ,TO FILL IN
NEAREST.
LEGAL `OWNER
DESCRIPTION LOT NO �� V
MAIL _
BLOCK TRACT ADDRESS '
NO. OF'BLDGS
s .
SIZE OF.LOT ? N W ON LOT CITY TEL NO. `
USE OF DISTRICT NO. GROUP MAP
BUILDINGS � � '
BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS , _
CITY NO. �' STSTATE
TATION DEPTH
MA OLE REFERENCE UP
�� Q WER
REGISTRATION N0. ❑
No. DESCRIPTION OF WORK FEE -01000
HOUSE SEWER CONNECTING TO TYPE OF NNECTION - LENGTH F '
Y. C P L. M L.T
PUBLIC SEWER @ $3 50 '
SEPTIC TANK,SEEPAGE PIT OR-
PITS AND/OR DRAINFIELD Q $3 00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD C. NO. - -
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO. IMP. NO. - OB N0.
HOUSE SEWER CONNECTING TO ,
PRIVATE DISPOSAL SYSTEM @- $1 00 TRUNK'PERMIT NO ROA RMIT N0.
CONNECT ADDITIONAL BLDG OR STATE ENCROACHM -
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSEINDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPR AL '
CHARGES
CON CTION CHARGE FEE
OWNER'SPERMIT $ 1 00
IMBURSEMENT FEE '
AUTHORIZATION 1, TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH-THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
'TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS Y OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK •'
OWNERS AGENT _ SEPTIC TANK,SEEP, PITS)
ADDRESS - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL Q '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY -ORDINANCES AND STATE LAWS REGULATING -ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND, -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL F-ROPERTY BACKFILL SEPTIC TANKS Q '
SEEP PIT(S) ❑ CESSPOOLS Q
SIGNATURE
PERMITTEE Z `
:)HN A LAMBIE, CourfTY ENGINEERLIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK J N 0 CASH '
. ' X9. 4 1z� N,�1i;�1 4� - .Q C L1
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDINGC11T/ � o � �� D�
ADDRESS r 1 Vi
FOR APPLICANT TO FILL IN LOCALITY 1�,Q,CJ (
BUILDING L 6 NEAREST
ADDRESS / ! LL�ILL-�. CR SS ST. J o� t d
LOCALITY DISTRICT NO. A SERIAL NO. PERMIT N0
A .
NEAREST �, 37 7/ 7 7 S
CROSS ST. 94a 1 i
M (� EIV 0.6y Ready far Inspection //DATE�jISSU�E•D�
OWNER C—L-1 f� +� i 6/ r�✓ —J /
MAIL USE ZONE OCCUPANCY MAP
ADDRESS BK PG
CITY TEL.NO. �Qdt, Gym �7
CONTRACTOR CO.IMP.N0. /2 74 —.2—
ADDRESS
JOB NO.
CITY2711'e6TELAO.
l TRUNK PERMIT N0.
REGISTRATION N � STATE Q _
COUNTY ROAD PERMIT NO. D S S
LEGAL
DESCRIPTION LOT NO. 93 PERMIT NO.ENCROACHMENT
BLOCK TRACT INDUSTRIAL
E
SIZE OF LOT �- X �'_$ N0.OF BL
NOW ON'LOT WASTE APPROVAL CHARGES �
USE OF /
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WO FEE 'e
HOUSE SEWER CONNECTING TO � �0 O
3.50 RECEIPT
PUBLICSEWER i REIMBURSEMENT FEE,.-
---,DATE— BY
HOUSE SEWER CONNECTING TO I �
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.Oft
WORK RECORDED-
WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING NO. DATE BYE'
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 /430. DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 !/ MANHOLE REFERENCE
' 720 / 1
LOWER
TYPE OF CONNE LENGTH FROM
Y. CURB TI P.L. M L.TO P.L.
OWNERS PERMIT $ 1 00 —r--
AUTHORIZATION I TOTAL FEE 4
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
e�
SIGNED THIS---------j!?---DAY OF----. -. . _ .19 NEW HOUSE SEWER
OWNER "'OR CONNECT ADDITIONAL
OWNERS AGENT
�r..�' P✓! ' BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S) -
ADDRESS - 7=-------------------------•--------•-------------------•-----• - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] 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 ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
' ER OF THE ABOVE DfSCRIBEA RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ,�'�/BB -� SEEP.PIT(S)E] CESSPOOLSER1
OF PERMITTEE------. _e�K1!leLlje ��-•- - -
76A642D 663 1/53