HomeMy Public PortalAbout9022 LAS TUNAS DR_Sewer__ -'76A642D APPLICATION FOR PERMIT 1
S @ E-663 12.64
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
• Depax ent of County Engineer —y
County of Lob Amgelea Ao RE SG 2D'12 - Z & / 1 4-4, n
WM. J. FOX, COUNTYTY EN ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL �+
DESCRIPTION LOT NO. OWNER
BLOCK TRACT a MAIL �YA
ADDRESS
SIZE OF LOT / Q NOW FLDGBLOTS J
,Q n/� CITY G TEL. NO.�
BUILDINGS USE OF IF_ 1 /Qr L 5S -*6I Q �L/L!/G7
DISTRICT NO. GROUP MAP
p.f BK PG
CONTRACTOR
ADDRESS `• eg CONNECTION DATA L.+
CITY TEL. N0. afr{r. �j k + STATION�'f'�O DEPTH
STATE 1
REGISTRATION N , �� ❑ COUNTY MAN PER FERENCE
TYPE OF CONNECT? LENGTH FROM
/40
NO, DESCRIPTION OF WORK FEE Y CURB P L. M L TO P.L.
HOUSE SEWER CONNECTING TO /S
PUBLIC SEWER Q $ 3 50 6-V
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
/ CONNECT ADDITIONAL BLDG. OR to-c> Co. IMP. NO. 7 JOB. NO.
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
EWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
_ S
DISCONNECT AND ABANDON SEWER STATE EN OACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 RGES
CONNECTION GE FEE
OWNERS PERMT $ 11L 00
AUTHORIZATION TOTAL FEE 5"0 RE RSEMCNT FEE
TRACTORHAVE TTO CONNECT THEHIS DATE AABOVE DESCRIBED EXCTED WITH THE ISTINGADWELLING MED CON- APPROVALS DATE INS ECTOR'S SIGNATURE
TO THE PUBLIC SE.W. Ry
wl
SIGNED THISNEW HOUSE SEWER
�_DAY OF 191 KK..
OWNER. OR q/j� CONNECT ADDITIONAL
OWNERS AGENT oO/��� BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT l 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
IHEREBY CERTIFY THAT I 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 PROPERTY. BACKFILL SEPTIC TANKS❑
/1 SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
� fl153r WV18 4 6.50
BY BY '
DEPUTY DEPUTY
BY By
:® DEPUTY DEPUTY