HomeMy Public PortalAbout9678 LAS TUNAS DR_Sewer__ ®® �,py ■meq_® �p,�� -- g�pgg PERMIT
}�. y��,gq
S AF-66 QTY■ PLIC T 6-=*,'l9 ! \ `b.w A 3M IT 1
$8:F:-6Fi3 12-54
DIVISION OF BUILDING AND SAFETY S L W - S E WAGE DISPOSAL
Department of County Engineer
County of Los Angeles
WP+I, J. FOX, GouNTv ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILD]NG
":.00RLITY�� ��L•w'^oI�ta C,'-_F` Y �_.
'
FOR APPLICANT TO FILL IN NEA'S ST.
LEGAL _._._.... _-,..,..�.�......-� �-- —
DESCRIPTION LOT NO. _ OWNER. .. A c.
BLOCK TRACTMAIL
ADDRESS
ESS
N0. OF BLDGS.
IZ
SE OF LOT _NOW ON OT CITY TEL. NO,
USE OF
_ ..�
B USLDlNGS_ _tm DISTRICT NO. ! GROUP MAP
-
CONTRACTOR1u : -
ADDRESS �g k; CONNECTION DATA
.CITYkj, {' ..q�°" TEL. N0. r STATION - DEPTri
E4—sTATE MANHOLE REFERENCE
REGISTRATION NO. (J
COUNTY
'UPPER_ _LOWER_-
TYPE OF CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.T_ M.L.TO P.L.
SEWER CONNECTING TO
-..d PUB.L!C SEWER_ _$ 3.50 ...." _;. -
HOUSE SEWER CONNECCING TO
PRIVATEDISPOSAL SYSTEM -
CONNECT.A:',DiTIONAL BLDG. OR CO. IMF. N0. JOB, NO.
WORK't'O HOUSE SEWER 5.00
ALTER OR REPAIR EXISTING
S t-FR OR DISPOSAL SYSTEM TRUNK PERFf CFO. ROAD PERMIT NO. �J
DISCONNECT AND ABAN ON SEWER i I STATE ENCROgLH'ENT
I Atr +- R DSP AL SYSTEM, _-_ 1.00 i PER hili NO.
r PTiC 1ANK SEEPAGE PIT OR --. '--'----
2 S AND/OR D,21` "dFi +D 00 IT JINDUSTRIAL
'- -- - -- WASCE APPROVAL
C OOL DRYWEL'_
Es!A CONDITIONS IONS ONLY 2.00 ! CHARGES._. ----- - - -- e----
---- -- - -- CONNECTION CHARGE FEE
O li"S PERNUT 1 00
AUTHOR TOTAL FEE
RE:MBt R?EFt-En,I rtyT�FEeT_�r
I HAVE THIS DATE CONTRACTED. WITH THE HEREIN NAMED CON- - APPROVALS DATE I SFECTOR�S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
- 70 THE PUBLIC 5 'VER �- {
a (s' NEW HOUSE SEWER
SIGI'[D TIII S. DAY OF 19 . __
OWNER OR -r• CONNECT ADDITIONAL -
OWN EaS AGENT__ ; ;. BUILDING ORWORK _.--
SEPTIC TANK,SEEP, PITS) -
ADDRESS ___
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL❑
. 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 -
L',CENSED .AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR T' 4T I A14 THE LEGAL OWNER OF THE. ABOVE kBANDON HOUSE�_aEVr'CtI
DESCRIBED RESIDEl`s IAL PROPERTY, r BACKFILL SEPTIC TANKS❑
SEEP_PIT(S) CEI CE§SPOOLS 0
SIGNATURE 0
OF PERMITTYE - -
WILLIAM J. F X. COUNTY ENGINEER VALIDATION �{
BY Y 4,,,5 ,C)
DEPUTY DEPUTY
BY BY ">
0 DEPUTY DEPUTY