HomeMy Public PortalAbout9067 LAS TUNAS DR_Sewer__ D
S IX-669 9-SS
APPLICATION FOR PERMIT 1
G 6 IX-663
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 BUILDIH6 LOCALITY AM
fJ
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT9 MAIL
L fr
ADDRESS
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO r
USE OF
BUILDINGS DISTRICT NO GROUP MAP
BK PG
CONTRACTOR C, !�(
ADDRESS -3 COONNECTION DATA
CITY r TEL. NO. n STATION j� DEPTH 7 '
9P-'TATE MANHOLE REFERENCE 6 J UPPER
REGISTRATI 0. O /rte ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO, LENGTH FROM _# a
Y CURB .L M.L TO P L VV
PUBLIC SEWER Q $ 3.50 -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR CO IMP. NO. 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 ENCROAC MENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
t o0
OWNER'S PERMIT CONNECTION CHARGE FEE
$
AUTHORIZATION I TOTAL FEE L/5 REIMBURSEMENT FEE
I ED HAVE THIS DATE CONTRACT1VITH THE HEREIN AMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE IN PECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS_ y
DAY OF 19 {' NEW HOUSE SEWER
6 S�
OWNER OR CONNECT ADDITIONAL t
OWNERS AGENT BUILDING OR WORK
:'r SEPTIC TANK, SEEP, PIT(S)
ADDRESS ° 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWN R OF TjiE ABOVE ABANDON HOUSE SEWER
91�SCRIBED IDENTOAdPROPE / BACKFILL SEPTIC TANKS❑
/(/,' �,y`� b'1r/`y�_ SEEP. PITS) ❑ CESSPOOLS
NATURE ��
OF PERMITTEE
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLEIG. INSPECTOR
Lto 6 6 9 3 .AIN 6 4 4.50 11