HomeMy Public PortalAbout9837 ESTRELLA AVE_Sewer__ S6 E-663 1256 D APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer Me
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County of Los Angeles ADDRESS BUILDING
WM. J. FOX, COUNTY ENGINEER
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CABBATT D. GRIFFIN, Sl1 P'T of BUILDING LOCALITY �
FOR APPLICANT TO FILL IN NEAREST
�� �- p- CROSS ST.LEGAL
DESCRIPTIO LOT 10'.9",lO ��rOlnix.c�` LY
OWNER�j �,
BLOCK TRACT 11, 712- MAIL
ADDRESS NO 1
/O A� /�O NOWON512E OF LOT // � /• s /J
L: lV/✓��` CITY .ILij � ' TEL. NO,a :,/ -
USE OF
BUILDINGS / //Q/ DISTRICT NO. GROUP K MAP PG
SjZCONTRACTOR �IQ > 1C/1/i0/1 r ST
ADDRESS I'.,�9 7 �� L S'j djMndj s' CONNECTION DATA
CITY //// TEL. NO. yil�� �G O Z STATION 97- G (J b DEPTH (G
/�/ / /O.fy z ❑ STATE 24 5/ M REFERENCE
REGISTRATION NO. ❑ COUNTY - -7- ( UPPER 1 LOWER
TYPE.04"[MIT ECT10 LENGTH FROM Z !-j
No. DESCRIPTION OF WORK FEE Y. /� cu RB 1 P.L. M.L.TO P.L. J
HOUSE SEWER CONNECTING TO (�•_ -
_ PUBLIC SEWER Q $ 3.50 �Y`
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. JOB( NO.
WORK TO HOUSE SEWER 1,00
Al TER OR REPAIR EX
SEWER OR DISPOSAL(SYSTEM EGO TRUNK PERMIT NO. ROAD PERMIT NO.3ZS0 p
SP"
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
.AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK. SEEPAGE PIT OR
PITS ANO/OR DRAINFIELO 2.00 INDUSTRIAL -
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s I Co
AUTHORIZATION TOTAL FEE SO REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH, THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'5 SIGNATURE
TO THE PUBLIC SEWER ""
SIGNED THIS AY OF lgytis-+ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGE N BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
_ADDRESS- AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ECT PLUG AND
ONN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ON HOUSE SEWER
CALIFORNIA OR THAT P AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL R PERTY. BACKFILL SEPTIC TANKS❑
- SEEP:PIT(5) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
{� p2112- JRN23 4 450 "
CBT By
DEPUTY DEPUTY
BT By
�® DEPUTY DEPUTY