HomeMy Public PortalAbout9670 LAS TUNAS DR_Sewer__ 76A 642D-CE808 A-7/76 APPLI CA ON FOR PERMIT
SEWER— EWAGE DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN DISTRICT NO. GRDUP K MAP Pi P O SSED BY
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BU ILDING .{1.g 41 r f - l .`� ..i I' D
ADDRESS ` �' .1�. L/:I _ --/ t'.•-i. i
Lacnurr
---- CONNECTION DATA
NEARESTSTATION DEPTH c y
CROSS ST. - , "�'�[>' _F4 E-yw13g - �UPPER/ f
MANHOLE REFERENCE
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OWNER /C,.,�s _ TYPE OF CONNECTION LENGTH FROM
MAIL r Y. CURB .L'R� M.L.TO P.L.
ADDRESS
P.C.IN
CITY CO.IMP.NO. r[..a JOB NO.
,y'�..[- - •TET.. O. -
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LCT NO.
AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. I DATE
BLOCK TRACT
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS "���"�,�''�- � „ STATE ENCROACHMENT
PERMIT NO.
CONTRACTOR �� o / INDUSTRIAL
WASTE APPROVAL
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ADDRESS ` ' /!� CHARGES C
CITY 7J rr77' CONNECTION CHARGE FEE v
STATE LIC REIMBURSEMENT FEE O
LICENSE NO. fC L A SIC_,NO. DESCRIPTIONOF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE W
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ z=j
NEW HOUSE SEWER
SEPTIC (ANK,SEEPAGE PIT OR Z
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL ...
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM SEPTIC TANK.SEEP,PIT(S) -.
CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD
WORK TO HOUSE SEWER @ —
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DR.YWELL ❑
EXTN..CESSPOOL.DRYWELL.MANIiOLE ALTER,REPAIR,SEWER OR —
ALTER.REPAIR OR ABANDON HOUSE SEWAGE DISPOSAL SYSTEM
SEWER OR DISPOSAL SYSTEM f
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS ❑ �`
SEEP.PIT(5)Kr CESSPOOLS
OWNER'S ilssuance Fee s
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AU'T'HORIZATION TOTAL FEE -- - ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- PLUMBING AND SEWERS.''•'yy
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING HEREBY CERTIFY I-yAT I AM PROPERLY REGIST ED AND/OR
TO THE PUBLIC SEWER. LICENSED AS REQ REO BY LOS ANGLES COUNT A D STATE OF
SIGNED MIS iJA F 19_ CALIFORNIA OR E LEG, NER D INTEND TO
pW r� (.� - RESIDE INABOVE DESC IBED EN L 0PERTY,
,
SIGNAT
OF PERMTTTEE
ALIDATIO
CK.
—149N`OCT U