HomeMy Public PortalAbout9844 ESTRELLA AVE_Sewer__ 7.1.42DAPPLICATION - FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
IN
County of Los Angeles BUILDING
WM. J. FOX. COUNTY ENGINEER ADDRESS p-
CASSATT D. GRIFFIN. SUPT of BUILDING
LOCALITY
FOR APPLICANT TO FILL IN ceoss ST.
LEGAL
DESCRIPTION LOT NO. ^J ( OWNER
BLOCK TRACT ! / MAIL
ADDRESS
C 10. OF SLOGS.
SIZE ®�' "'' NOW ON L0� CITY . TEL. N0. /¢ Z11 I
USE OF
BUILDINGS 'i//.J.� n DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR (,(,� L �'
ADDRESS J 3 CONNECTION DATA
CITY ,T TEL. N0. meq+ STATION S/ DEPTH d
STATE
REGI STRATIO O.
,_ C1_0 COUNTY yy A!ANHOLE REFERENCE -LOWER
TYPE OF CONNECTION LENGTH FROM pit
NO. DESCRIPTION OF WORK FEE ^ - CURB SsS- M.I. TO 1.1. Ot O
HOUSE SEWER CONNECTING TOPUBLI3� ,
HOUSE EWER Pb 5 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
_ WORK CONNECT HOUSE NALSEWEBBLDG. OR 100 CO. IMP. NO. JOB. NO.
.ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM L00 TRUNK PERMIT NO. ROAD PERMIT N0.
DISCONNECT AND ABANDON SEWER R STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0.
-SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
.SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00 ,
AUTHORIZATIOTOTAL FEE —� vCi' /g REIMBURSEMENT FEE
N
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE 0 5CRIBED EXISTING DWELLING APPROVALS DATE INSPPEECTTOO�RR�'$SIGNATURE
TO THE PUBLIC SSW'f D Y OF R
SIGNED'(HIS
t. �`� NEW HOUSE SEWER
.J.JJ79 1
OWNER OR Cly CONNECT ADDITIONAL
OW NEP.S E, -BUILDING OR WORK
SEPTIC TANK, SEEP, PIT($)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORD114AN CES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SELVAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
"
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW
CALIFORNIA OR THAT 1 AM THE LEGAL OWN OF THE ABOV _
DESCRIBED RESIDENTIAL P OPERTY. BACKFILL SEPTIC TANKS❑
P.
PIT
($) Cl CESSPOOLS
SIGNATURE /
OF PERMITTE
WILLIAM J.FOX, C TY ENGINEER TION
DEPUTY `}�/� 5. DEPUTY
'BY BY
DEPUTY DEPUTY •qr