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HomeMy Public PortalAbout9668 LAS TUNAS DR_Sewer__ E�663 3-55 APPLICATION FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING UILDsG w t x - � `WM.J. FOX, COUNTY ENGINEER r CASSATT D.GRIFFIN,SUP'T OP BUILDING LOCALITY �q r FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL DESCRIPTION LOT NO. �. -� vOWNER Al _BLOCK TRACT -_ADDRESS --b - r S?ZE OF LOT NO. OF BLDCS.�+� NOW ON LOT .. CITY Y�;;,,. �` � a TEL. NO. ^USE OF `BUILDINGS ,a7i' �e'',..i+" _ DISTRICT NO. I GROUP MAP "'ter-__•'_.—_T-�- BK PG CONTRACTOR ® - 'tet ADDRESS CONNECTION DATA KESS - s_ ... +' L. NCI'" . ,�0-� 5TATION _ _,l DEPTH-� STATE MANHOLE REFERENCE ,�"' _ ___UPPER_ REGISTRA71ON NO. ' j6 COUNTY __—__�_� �_ �, r - 3NER - NO. DESCRIPTION OF WORK FEE TYPE OF CONNECT(V15 LENGTH FROM HOUSE SEWER CONNECTING TO � - _ PUBLIC SEWER_ (u),-$ 3,50 _,,____^__ ­PRIVATE HOUSE SEWER CONNECTING TO _ PR VATS DISPOSAL SYSTEM 1.00 —� CG iNECT ADDJ'TiONAL BLDG. ORP. C NO. WORK TO HOUSE SEWER 1.00 CO. IMP. NO. �_t_^30$ ALTER OR REPAIR EXISTING - --- - --_ StNER_OR DISPOSAL SYSTEM _ 1.00 ^� TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND.ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM - 1.00 PERMIT N0. _1-- _ -_- _ _I_�____. �. SEPTIC TANK4 SEEPAGt PIT OR � --- ___.__-.—----- NIS ._P IS AND/OR DRAINFIELD 2.00 INDUSTRIAL C�.,SPOOL D.i,'YItEL -- WASTE APPROVAL SPi CiAL C01u©!1-IONS O'dLY 2.00 CHARGES I -- - --' CONNECTION CHARGE FEE Oi�FNER'S PERMIT g, S� 00 ,�___ - AUTHORIZATIOI4 TOTAL. FEE �j� � REIMBURSEMENT FEE INSPECTOR S SIGNATURE 1HAVE THIS DATE CONTP.ACTED WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABCVE DESCRIBED EXISTING DWELLING �-�_--_ TO THE PUBLIC SEWER 6.4 SIGNED TH:S— -c�D/ 1Y OF `� °�y° ar�. NEW HOUSE SEWER �' CONNECT ADDITIONAL i OWNER OR �"' g �LL��� � OWNERS AGENT <' 9�"�+'`'- BULLDING.OR WORK SEPTIC TANK, SEEP, PIT(S) AQDP ESo _ - &A:ND!OR DRAINAKELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYW�ELL❑ AND 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 I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ----- -- LICENSED AS REQUIRED BY LOS .ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND -CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSESEKWER DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS(=; SEEP. PITS) EI CESSPOOLS O I - SIGNATURE OF PERMITTEE.— _N —.�-• WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR 'T