HomeMy Public PortalAbout9906-9910 LAS TUNAS DR_Sewer__ D
5&E-663 12-54 APPLICATION FOR PERMIT 7
5&E•6 1
DIVISION OF BUILDING AND.SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles �7ADDRESS
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WM. J. FOX, COUNTY ENGINEER q [ �, ��we �bCASSATT D. GRIFFIN, SUPT OF BUILDING GM=f
FOR APPLICANT TO FILL IN .
LEGAL
DESCRIPTION LOT NO. OWNER _
BLOCK TRACT MAIL- 1
NO F BLDGS. ADDRESSj{��d
SIZE OF LOT NOW ON LOT CITY � j�Q4EL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP
^� BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
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CITY , TEL. N0. STATION �G�- _37 DEPTH
A
REGISTRATION NO. //L /J/ ❑ COUNTY � • i� UPPER REFERENCE
_ INQAW
YYyv TYPE NE ION LENGTH OM /J 0
NO. DESCRIPTION OF ORK FEE Y. CURB) P.L M L TO P FRL
HOUSE SEWER CONNECTING TO
•PUBLIC SEWER $ 3 50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR {�
_ CO. IMP. N0.WORK TO HOUSE SEWER 1 00 �,/ JOB. NO.
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT
DISCONNECT AND ABANDON SEWER - STATE ENCROACHMENT
PND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DPYWELL WASTE APPROVAL
,SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT- $ 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DA E �NSPEC IGNATURE
TO THE PUBLIC SEWER _
r'► NEW HOUSE SEWER
SIGNED THIS DAY OF t ,�
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN BUILDING OR WORK
ADDRESS { ` SEPTIC TANK SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA ON CESSPOOL❑ 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
LIFORNIA O THAT I AM THE LEGAL OW NE OF TH BOVE
ESCRD R E ROPER BACKFILL SEPTIC TANKS❑
SEEP: PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
deo 5 5 7 5- JUL•13 4 4.5 0
BY By
DEPUTY DEPUTY
BY BY
,A) �'•' DEPUTY DEPUTY \/ ,