HomeMy Public PortalAbout9179 FORTSON DR_Sewer__ 76A642D �/ CAT I O.Y , ■ O■ o PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCAL=
FOR APPLICANT TO FILL IN NEAREST
1.7
CROSS ST. y
LEGAL _ P
DESCRIPTION LOT N0. ,1 OWNER r Ef /
ff�' r
BLOCK TRACT U MAIL q
_ ADDRESS (
NO. OF BLDGS. �� ��r (—
SIZE OF LOT NOW ON LOT,, �y� TE Ar f2-) �
USE OF 9 .`
BUILDINGS 'j/6.a '}..� dam- DISTRIC NO. GROUP MAP
CONTRACTOR BK PG
CONNECTION DATA
TEL. 1 f ?2 �A STATION �' Z DEPTH
/ —S ATE
MANHOLE REFERS-NCS
REGISTRATION NO. � �� ❑ COUNTY UPPER ,� j LOWER
TYPE OF CONNECTI L NGTH FROM
NO. DESCRIPTION OF WORK FEE Y• CURB P.L. M.L. TO P.L.
HOUSE SEWER CONNECTING TO v
PUBLIC SEWER @ $ 3 50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0, t O I JOB. NO.
_ WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER 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 APPROV
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHM16 FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE �`� RF.IMBUR EMENT FEE
TRACTORHAVE TO DATCON CTO T HEA ABOVECTED WDESCRITH H ED EXISTINGIN DWELLING
DW ELLIMED ONG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE RU LI
- EWER q
SIGNED THI DAY O 19 NEW HOUSE SEWER
OWNER 0 CONNEC
OWNERS AGENT
T ADDITIONAL c�
BUILDING OR WORK
"�r , SEPTIC TANK, SEEP, PITS)
ADDRES AND/OR DRAINFIELD
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
1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTjERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY ppND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OW ER OF THE ABOVE'
DESCRIBED RESIDENTIAL OPERTY. -BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑. CESSPOOLS1y 2SSs' VW F!/Nitl�T/.!F
SIGNATURE
OF PERMITT
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
BT C '5 9 2 C JUL 2 54 45 ,n
DEPUTY ~DEPUTY
BY
BY
® DEPUTY - DEPUTY