HomeMy Public PortalAbout9085 LAS TUNAS DR_Sewer__ S&E•663 12-34 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING U �q
WM.J. FOX, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER pOf
BLOCK TRACT 1 , MAIL
%ADDRESS
NO. O BLDGS.
SIZE OF LOT _ �\ NOWT LOT CITY
_ � TEL NO
USE OF '��'',I, '•-.-.
BUILDINGS ,I I. 1,`� L \ '� v DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR /
ADDRESS `Z- r CONNECTION DATA
CITY TEL. NO. STATION �' r 2.. DEPTH
yy ry STATEJ� , � eiAry AER � �
REFERENCE
REGISTRATION NO. j // A •/C� COUNTY
TYPE OF CONNECT] LENGTH FROM
NO. DESCRIPTION OF'WORK FEE Y. CURB L. M L TO P L
IHOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3 50 D
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR CO. IMP. NO. "��9 JOB NO.
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD tE&WT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0. '
SEPTIC TANK, SEEPAGE PIT OR
ITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
OWNER'S PERMIT g 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE '50REIMBURSEMENT FEE ___N
I HAVE THIS DAN
TE COTRAC WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT T BOVE DES RI BED X]STING DWELLING, APPROVALS DATE` INSPECTOR'S SIGNATURE
TO THE PUBLIC W
NEW HOUSE SEWER 1@ a't
SIGNED THIS DA OF
CONNECT ADDITIONAL
OWNER OR ,, BUILDING OR WORK
OWNERS �(A' J(
+� n'=- ��� ���>=�-'� SEPTIC TANK, SEEP, PITS)
ADDRESS`//
1 r/ c AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 1 AM THE LEGAL OWNER F THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) ❑ CESSPOOLS
SIGNATURE
OF PERMITTE
WILLIAM J. FOX, COUNTY GINEER 4116MATION
BY iso 9B 3 7 7,n OCT 2 5 4 4.50
. DEPUTY cDEPUTY
BY BY
'.® DEPUTY DEPUTY /
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