HomeMy Public PortalAbout9909 LAS TUNAS DR_Sewer__ APPLICATION'.FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING 99 O /�
h/ j �v
t. WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSST
1 �•'-�� S�
LEGAL
DESCRIPTION LOT NO. J OWNER rte— ,* !
BLOCK TRACT MAIL
ADDRESS
NO.OF
SIZE OF LOT 70 j;1 11 NOW ONBLOTS -
CITY _ TEL NO.
USE OFrnlTQL .
BUILDINGS /'` �'1 1•> L,C� DISTRICT NO. `GROUP BK MAP PG /
CONTRACTOR G I� O S -l Y M B I/� C O , I P_ yL I /;;z-
ADDRESS 801ON f: V . CONNECTION DATA
CITY �OV�- TEL. NO. V -7- ��`y(g STATION h DEPTH
REGISTRATION NO. �p / LJ COUNTY STATE MA UPPER 06LE REFERENCfr��' u/f d LOWER
TYPE O�Fr-:C&NNECTION LENGTH ROM v /
NO. DESCRIPTION OF WORK FEE Y. / URB) P L. M L TO P L
/ HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER Q $ 3 SO v n
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG. OR CO. IMP NO. `� JOB. NO.
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING �J
_ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 100 'PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHAR
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION , TOTAL FEE r REIMBURSEMENT FEE
HAVE IT CTORTTOS DATE CONNECTO THEAABOVECTED WDESCR BED EXESTINGA DW ELLMED �NG APPROVALS DATE IN PECTOR'S SIGNATURE
TO THE PUBLIC SEWER - NEW HOUSE SEWER
SIGNED THIS-DAY OF 19-
OWNER OR - CONNECT ADDITIONAL -
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT($)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL[3AND 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS Cl
p; - (� y SEEP.PIT(S).❑ CESSPOOLS❑
SIGNATURE
OF PERMIT E -
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
BY Ao3 B1 3 3n SEP 20 4 4.50 �
DEPUTY DEPUTY /
BY BY 1 _ ` I 41—
DEPUTY
DEPUTY DEPUTY