HomeMy Public PortalAbout9855 ESTRELLA AVE_Sewer__ 12.5. APPLICATION FOR PERMIT
:Y6CE.6eDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL dS
Deportment of County Engineer
County Of Los Angeles AB UL
DDRESSGI J'
WM.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN.SUWT GF BUILDING - LOCALITY]
FOR APPLICANT TO FILL IN NEAREST i
CROSS ST.I
LEGAL
DESCRIPTIO! LOT NO. 9 OWNER
BLOCK ' TRACT MAIL
�^ ADDRESS J
SIZE OF LOT .,/� �I NO. OF BLDGS. / { X16
NOW ON LOTS CITY t TEL. NO.
USE OF
BUILDINGS DISTRICT NO, GROUP MAP G
CONTRACTOR
s.
LK� SP 1
ADDRESS ',p% CONNECTION DATA
C
CITY A- TEL. NO.AO 4/Lf CP Cc? 74,-'71-IIS,
DEPTH
STATE 4-74-7
�3 ❑ COUNTY W MANH�O REFERENCE
REGISTRATION N0. OWER
TYPELTSgIJNECTiON LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CU B P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO T1
PUBLIC SEWER to S 3.50 D
HOUSE SEWER CONNECTING TO C-
_ PRIVATE DISPOSAL SYSTEM LOD __ �j a
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. /3 J JOB. NO.
I WORK TO HOUSE SEWER I.00. _
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT NO.J
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
ANO/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYW ELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S '1'. 00
AUTHORIZATION TOTAL FEE SQ REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAAD CON-
- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
/ NEW HOUSE SEWER
SIGNED THIS DAY OF 19 19
OWNER' IOR � i�,/ '{/A A CONNECT ADDITIONAL
RWORK
OWNERS AGENT + / V7n/!// BUILDING WORK
SEPTIC TANK,SEEP, PITS)
ADDP.ESS� AND/OR DRAINFIELD
I 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 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 PR P RTY. BA CKFIIL IS TANKS❑ iJ
SEEP. PIT(S).❑ CESSPOOLS _ - q /�
SIGNATURE /
OF PERMITTEE _
WILLIAM J. FOX, 6OUNTY ENGINEER VALIDATION
;lo9B 5 On OCT
By A ] 4 4,50 16
DEPUTY - 05PUTT
BY BY /yj/�{�yR}/�/��
�'® DEPUTY EP"O UTY