HomeMy Public PortalAbout9109 LAS TUNAS DR_Sewer__ 76A6420 APPLICATION -FORPERMIT
S&E•663 12.54 1
DMSION 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';"SuP'T 6F'.BuILDING .LOCALITY -
ti _ FOR APPLICANT TO°FILL IN ceoss sr. y
e 'LEGAL - J
DESCRIPTION 'LOT NO. __ / OWNER
BLOCK TRACT 4 Mir MAIL
-� ADDRESS
NO. OF BLDGS.
,SIZE OF LOT NOW ON LOT CITY 14L. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAPS
_ M.C. K PG
M
CONTRACTOR Nottingham Co. of So. I *Z I.
ADDRESS 5933 N. Cloverly Ave, CONNECTION DATA
CITY Te le City TEL. NO. FO-8-0330 STATION DEPTH
LK STATE MANHOLE REFERENCE
REGISTRATION NO, 147012 ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
_ -PUBLIC SEWER Q $ 3.50r-}=—
HOUSE SEWER CONNECTING TO -
_ PRIVATE DISPOSAL SYSTEM 1.00 _o„ ® eI
{CONNECT ADDITIONAL BLDG. OR
'CO. IMP. NO. JOB. N0.
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 NO.
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL _ WASTE APPROVAL ,l
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL`FEE 00 REIMBURSEMENT FEE
I HAVETHIS DATE CONTRACTED WITH THE H REIN NAMED -CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
ALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC ,SEW NEW HOUSE SEWER `k !
SIGNED THIS AY OF 19- _
CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK, SEEP, PIT(S)
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 I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND, -
CALIFORNIA OR THAT t AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER -
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑.
M.C• Notting C' • Of - .v Cal i•' SEEP.PIT(S) ❑ CESSPOOLS❑
"
.SIGNATUREOF PERMITTEE tT
r
WILLIAM'J.'FOX, COUNTY ENGINEER " VALIDATION
Alp
BY 4 0 9 91S 'rmy 2 5 4 2.0 .0 '
DEPUTY +- DEPUTY
BY
.. - BY
T) DEPUTY DEPUTY