HomeMy Public PortalAbout9136 LAS TUNAS DR_Sewer__ (per gq( �r+�p 7
,.5&E•6f.3 12.54 APPLICATION,.
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MIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Tz",vg.„� � e�q
FOR APPLICANT TO FILL IN CROSS T /�? I
LEGAL
DESCRIPTION LOT NO. c OWNER
BLOCK TRACT O S _ MAIL
ADDRESS
SIZE OF LOT �x 13 r NO. OF BLDGS. VY w
NOW ON LOT CITY N
USE OF
BUILDINGS �`�"�j =t4 e DISTRICT N0. GROUP MAP
T !
CONTRACTOR J 4- � T LAw,-"'1 a :r-t4 Lo , I i (/ I T�
AADRESS ! /J 9-o4,,.4,_j ' CONNECTION DATA
TEL. NOA17 77 STATION 64- f DEPTH
////1111 STATE MANHOLE REFERENCE
REGISTRATION NO. y l/^ ❑ COUNTY- TYPE ECTION LENGT FROM
NO. DESCRIPTION OF WORK FEE Y. P.L. M.L.TO P.L.
I HOUSE SEINER CONNECTING TO @ $ 3.50 ;f'2 15-
PUBLIC SEWER
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. Z�,P9 JOB. NO.
WORK TO HOUSE SEWER •1.00
ALTER OR REPAIR EXISTING T
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO._ 0
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 O�
CESSPOOL- DRYWELL WASTE APPROVAL Www'✓
SPECIAL CONDITIONS ONLY 2.00
- CHARGES ✓�'�
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION TOTAL FEE qI 0.
REIMBURSEMENT FEE
I HAVE THIS...DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DAT IfSPECTORS SIGNATURE
TO THE PUBLIC SE ER 1y � _
SIGNED THIS D Y OF OW::/ 19 NEW HOUSE SEWER le 2b 5 J✓'"`0
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL El DRYWELL[IAND 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED R IDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. F OLINTY ENGIiVER VALIDATION
�Co 9 2 8 O� OCT 24 4 4.5 0 M
:BY BY _
DEPUTY
"DEPUTY
BY BY
• ® DEPUTY DEPUTY