HomeMy Public PortalAbout9161, 9161 1/2, 9161 3/4 LAS TUNAS DR_Sewer__ DEPARTAMVT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
,,,RVISION OF BUILDING AND SAFETY PERMIT APPLICATION
> COUNTY OF L08 ANGELES I BUILDING ���
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS /Gi / �r�0�
FOR APPLICANT TO FILL IN LOCALITY
BUILDING /. NEAREST 0
ADDRESS (/ CROSS ST. S
LOCALITY /1 l DISTRICT NO. SERIAL NO. /yPERMIT NO.
NEAREST CJ A �/ 7/3 S
CROSS ST.
��J�d f� REC VED Y Ready for Inspection ATE ISSUED
OWNER �� //./ .+ Z
MAIL yz�
ADDRESS USE ZONE OCCUPANCY BK MAP PG
- '
CITY TEL.NO.
CONTRACTOREms• �r/ /,� 'l.(i/� CO.IMP.NO.
ADDRESSQ JOB NO.
�J 2 �-4 TRUNK PERMIT NO.
/ -
� +1 SLS T
REGISTRATION NO. ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. 4 -
, D PERMIT NO
BLOCK TRACT INDUSTRIAL �yGS7_1e �J�:
WASTE APPROVAL �!G .0
NO.OF
SIZE OF LOT Z C X Z�NOW ON LOTS CHA ES
USE DI 57�-y�-5 „/ �1W�7 Jl CONNECTION CHARGE EE
BUILDINGS (y�C `l- /T/,(�/
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 5 SO RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTI RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I ATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEP IC TANK.SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ANHOLE REFERENCE
, 'e.I~� LOWER'
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; I 00 Q= .CURB ( M.L.TO P.L. ZQ
AUTHORIZATION I TOTAL FEE -
1 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-------_..____.._....... NEW HOUSE SEWER d c � -7-
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 APPLI- CESSPOOL[:] DRYWELL
CAT
IONAND 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIF NIA OR THAT 1 AM HE LEGAL OWN-
ER OF THE ABOVE S RIBED ESI VLZPP R^Y. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS[:]
OF PERMITT _ _.-- -_._- -
76A642A 663 7/53 J In