HomeMy Public PortalAbout8839 LAS TUNAS DR_Sewer__ I
/anaezD
CE 808(REV6178) APPLICATION .FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF'LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT ND, GR.UP MAG _yfl.CERSID EY
BK ! PG
BUILDING e /f /( ' F •Y" 1 '. AN� '� �� ?�/ � /r1
ADDRESS�fy
1- 'IFZ+
CONNECTION DATA'
LOCALITY f
NEAREST+'� y - STATION DEPTH
CROSS ETj(r�. UPPER
t MANHOLE REFERENCE'
�'rl 1./Y#� _ l � LOWER
TYPE OF CONNECTION LENGTH+ FROM
MAIL ' ✓� T( i/+ 'J� J( Y. CURB P.L. M.L.TO P.L.
ADDRESSYia f/ So AN'/L" 6{�l -
P.C.NO.
✓
CO.IMP.NO. JOB NO.
cITYl7 TEL.rvo.
LEGAL` - TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOTNO.
AFFIDAVIT WAIVER- EASEMENT RECORD,INSTR,NO. DATE
BLOCK TRACT - '
SIZE OF LOT/i`'I] 1• NO. ON LOGS. r1
1 (•I F•T NOW ON LOT HWY.OR BT.WIDENING
USE OF
.. !, STATE ENCROACHMENT
BUILDIDINGs�a/YtF•1 f1 f PERMITNO.
CONTRACTOR -/'f INDUSTRIAL
p.� qJ t WASTEAPPROVAL
ADDRESSQi1 " IJfFY� N...� lFl ( / ' CHARGES
TEL.NO.5 CONNECTION CHARGE FEE O
STATErr // V LIC. REIMSURSEM ENT FEE
LICENSE NO-J' Y CLASS V
NO. DESCRIPTION OF WORK I FEE APPROVALS DATE INSPECTOR'S SIGNATURE J
HOUSE SEWER CONNECTING TO _ LL
PUBLIC SEWER
NEW HOUSE SEWER >.SEPTIC TANK.SEEPAGE PIT OR
Ix
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO SU ILDING OR WORK 9
PRIVATE DISPOSAL SYSTEM
ay• .f STANK.SEEP
IT51 O
CONN ITOBLDG.OR AND/OR DRAINFIELD
_WORK TO HOUSE SEWER
'
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL [I DRYWELL❑ F
EXTN.,CESSPOOL.DRYWELL,MANHOLE
ALTER.REPAIR OR.ABANDON HOUSE ALTER,REPAIR.SEWER OR '
SEWER OROLSP,pSAL'SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNEcT PLUG AND
ABANDONHOUSE S_EWER
' BACKFILL SEPTIC TANKS❑
OWNER'S PermitSEEP.PITISI CESSPOOLS❑ '
" ' . �e
AUTHORIZATION TOTAL FEE d VALIDATION
, u
I HAVE AT THIS DATE"A CONTRACT WITH THE HEREIN NAME.CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,
W
TO THE PUBLIC SEWER.
51GNEDTHI5 DAY OF 19— �•,T "S
OWNER OR !
OWNER5AGENT f. f_.. 1 !/ 1".f (:�I i�.. ) F'•` ( •i II�•IL1
ADDRESS -' /��
Ori�L✓ lr :A "T{ t{li. V ' .
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '
AND STATE THAT THE ORDINANCES
IS CORRECT AND AGREE TO COMPLY ! *,('
WRM. IN COUNTY ORDINANCES ANO STATE LAWS REGULATING I -nl [J
PLUMBING AND SEWERS.
LNHERESED A CERTIFY THBY LOM PROPERLY REGISTERED ANO/OR ;J;".1•j r-K"H .F .
LICENSED AS REQUIRED TH LOY AI GOWNEROF.ACOUNTY AND STATE OFCALI
SIDE ORNIA 0N.THEARTHATISCRIBEy£GALOWTIALPR AND INTENDTO RIE-
SIDE
E- . -
SIDEIN.THE ABOVE D`E/SDRIfB(EO�JJIRESIDENTIAL PROPERTY. . I
SIGNATURE �j �f �/J�:. i �ryy"�•
OF PERMTfEE
�I