HomeMy Public PortalAbout9127 LAS TUNAS DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
OF BUILDING AND SAFETY PERMIT APPLICATION
COUNT' OF LOS ANGELES ) BUILDING ] 7
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLI TO FILL IN LOCALITY-CANT /I
BUILDINGNEAREST ool
ADDRESS �f� . ,tom+ CROSS ST. L
LOCALITY w` DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST �J A J
CROSS ST. ,
� RECE.IVED BY Ready for Inspection / DATEtIS/SUE�Ds
OWNE
MAIL
ADDRESS d ` USE(ZONE OCCUPANCY tRh4W
3BK PG
CITY TEL.NO;� � '� ee: + 3
CONTRACTOR, CO.IMP. NO.
ADDRESS ! JOB NO.
CITY ./.d3 TEL.NO. TRUNK PERMIT NO.
STATE —REGISTRATION NO. J,0 G/-S-6 g COUNTY. ROAD PERMIT NO.
LEGAL. STATE ENCROACHMENT
.DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT �a� INDUSTRIAL �r� c
WASTE APPROVAL QN 71-C
SIZE OF LOP,t� x NOW ON LOTS CHARGESUSEOF
BUILDINGS CONNECT OI N'CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO \�
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTION RECORDED
WORK TO HOUSE SEWER L00
ALTER OR REPAIR EXISTING NO. I DATE BY '.
_SEWER OR DISPOSAL SYSTEM I.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR `_P
PITS AND/OR DRAINFIELD 2.00 STATION 2+60_6 DEPTH
CESSPOOL—DRYW ELL ri
SPECIAL CONDITIONS ONLY 2.00 r, / MAN}I,O,LF�REFERENCE
,'SCI PP E CQ:WE�R.
TYPE OF.CONNECTtL LENGTH.FROM p►/
OWNERS PERMIT $ I 00 dy- P.L' M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER //
SIGNED THIS--------------------DAY OF........................................ 19..._.... . NEW HOUSE SEWER jG Y/9GK ��`c.
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..................................................................... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-------------------------------------------------------------------------------------------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[-] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS
�
SIGNATURE
SEEP.PIT(S)C3 CESSPOOLS 0
,r7
OF PERMIT ` _.._..._- .......----. ..
!� 76A642A 663 7/53 /�