HomeMy Public PortalAbout9170 LAS TUNAS DR_Sewer__ DEPARTMENT OF COUNTY ENG.1 1—R ! -SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY % PERMIT APPLICATION
COUIVTY',OF LOS-ANGELES
}� WI LLj'AM J., FOX, COUNTY ENGINEER BUILDING
T.rrD.t;GRI'FFIN ISuasT DF,BUI�DING. „� ADDRESS
CASSAT �� �
»F®�RwAPPLIC �NfT>TOFILL_ IN= — tOC`ALITY ,
BUILDING, -- �, NEAREST ,/ !f
y �._ .. S.1S/
^ ADDRESS`-���`� _{-'a€i� y4/�. �r�i� �� GROSS;ST.
1 '} w`• -� '" .?� ^DIST` T'NO v SERIAL N0. PERMIT N0.
LOCALITY
NEAREST'
A ,� � �
CROSS ST:, i
RECEIVED BY Ready for Inepeotlon DATE ISSUED
OWNERC<Z3
MAILSE ZONE OCCUPANCY MAP
ADDRESS` I BK PG
CITY EL. 0. I
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS REQUIRED }
NOT REQUIRED /
JOB N0. CONNECTION CHARGF
E EE'
�A/'!. r
REGISTRATION NO.e,.3, J f ft_,jX CO NTY t CO:IMP NO .tf
LEGAL is I RECEIPT NO DATE' I BY
DESCRIPTION LOT NO.
BLOCK TRACT ., WAIVER FOR RECORDING
SIZE OF LOT �?, NO.OF BLDGS. RECEIPT N0. I DATE I BY
NOW ON LOT
' USE OF �
BUILDINGS TRUNK PERMIT N0.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOROAD.PERMI,TNO.
PUBL'ICSEWER @ $ 3.50 I SATE ENCROACHMENT
HOUSE�SE.WER{CONNECTING TO p
PRIV?ATE,DISPOSAL•SYSTEM 1.00 I 'PERMIT NO.
WORK TO�HOUSEpISEWER LDG.OR 100 I p ;WASTE APPROVAL BY L+ DAT �^
ALTTN REPAIR EXISTING
SE,W�ERMWDISPOSAL SYSTEM 1.00 t .` CONNECTION DATA
,DISCONNECT''AND ABANDON'SEWER
AND,'%O,Rt,DISPOSAL SYST EM 100 I STATION ,,L,C �, t DEPTH
SEP.__ TANK,SEEPAGE PIT OR
PITS AND/OR'DRAINFIELD 2.00 I MANHOLE REFERENCE ,_ C/�
CESSPOOL—DRYWELL U Pg x �—' L'OWER
SPECIAL CONDITIONS ONLY 2.00 i � - /�
TYPE OF CONNECTION LENGTH FROM 6oo
Y-,---- CURB P L. M.L.TO P.L.
OWNERS PERMIT $ I 1 00 _
AUTHORIZATION- TOTAL FEE, - 11.E c k f3'
I HAVE THIS DATE CONTRACTED:WITH THE HEREIN NAMEDf
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 �_7CIn/...�.-+.eJl� S 0 i� 3
„ =
OWNER OR- i y`CONNECT ADDITIONAL
OWNERS AGENT................_..:_.__......._..-._..__ BUILDING OR WORK
------. ----•------------•--I -SEPTIC TANK,SEEP.PIT(S)
AQDRESS_._._ .:_ - ----------_. AND/ORDRAINFIELD
1 HEREBY,ACKNOWLEDGE;TIHATa;I HAV,E,READ THIS_aAP,PL`h CESSPOOL❑ DRYWELL❑
`,CATION-AND.STATE THAT-,THE ABOVE IS7CORRECT-AND AGREE, '
a TO COMPLY-WITH-ALL-COUNTY,ORDI,NANCES AND,STATE LAWS QQ ALTER,RE PAIR SEWER
REGULATING?PLUMBING A'ND,SEWERS. i 5 SEWAGE DISPOSAL SYSTEM
I- HEREBY CERTIFY THAT 'I AM -PROPERLY REGISTERED' 'DISCONNECT PLUG AND
AND/OR LICENSED AS_REQUIRED,-BY- LOS ANGELES CLOUNTY t
BANDON HOUSE,SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAOW -
EROF THE ABOVEDESCRIBED REST ENTIAL PROPERTY BACKFILL SEPTIC TANKS E]SIGNATURE / SEEP.PIT(S) CESSPOOLS
Ej
OF PERMITTEEC.�- .... .. .
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