HomeMy Public PortalAbout9130 LAS TUNAS DR_Sewer__ AEPAKTbIENNT OF COUNTY ENG1NEEB SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLIC T TO FI IN LOCALITY
BUILDING s� NEAREST
ADDRESS / CROSS ST.
LOCALITY DISTRICT N0. I Ready for Inspection I PERMIT NO. c
NEAREST J
3 7
CROSS ST.
RECEIVED BY DATE
II ED BY DATE
OWNER / csG
L
MAIL ADDRESS USE ZONE OCCUPANCY V MAP
BK PO
CITY TEL.NO.
CONTRACTOR /U
Co.IMP.N0. f�
ADDRESS
t JOB N0.
♦:: /
CITTEL.NO. A � �� / TRUNK PER IT N0.
REGISTR N0. COUN
ON• TY ROAD PERMIT
LEGAL
DESC PT NJ T NO. B� STATE ENCROAC ENT
Qr PERMIT NO.
BL K TRACT �/O INDUSTRIAL
WASTE APPROVAL ol
SIZE OF LOT lQ NO SON LOTS ARGES
USE OF
BUILDINGS _ CONNECTION CHARGE E
NO. DE RI I F W FEE
HOUSE SEWER CONNECTING TO _ REIMBURSEMENT EE
PUBLIC,SEWER @ $ 3. 0 RECEIPT i 131E I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO.OR EXCEPTION RECO ED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE \jBY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION /-7<"'5 y DEPTH 9v�
CESSPOOL—DRYWELL i
SPECIAL CONDITIONS ONLY 2.00 MANHOLE.REFERENCE LOWER
�!5L a- 2
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y• CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE -
1 HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
HAVE
TO NN CT THE AB VE DESCRIBED EXISTINGAPPROVALS INSPEC OR'SSIGNATURE DATE
DWELLING TO T}H�E LIC SEWER
SIGNED THIS— /qG OF I�� NEW HOUSE SEWER l p� mi4
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-------_.- BUILDING OR WORK
ADDRESS..97/ EPTIC TANK,SEEP.PIT(S)
.. _._.....____.�._.�.._w_.._.._ _. ._.. AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL I] 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED B��(( LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNI OR fi I A HE 0 ABANDON HOUSE SEWER
ER OF THEA V ESC I E T Y. BACKFILL SEPTIC TANKS
SIGNATURE r C� SEEP.PIT(S)E] CESSPOOLS
OF PERM ITTEE--L..
76A642D S&E 663 4/5 Q: