HomeMy Public PortalAbout9420 LAS TUNAS DR_Sewer__ 7GA642D APPLICATION .
PERMIT
6&E•663 12.54 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE -DISPOSAL
DepoTtxnent of County Engineer
County Of Lc6,Angeles BUILDADDRESS
C/ n �r x •�y��
WM. J. FOX, COUNTY ENGINEER ADDRESS / �y j
CASSATT 0. GRIFFIN,SUPT OF BUILDING - LOCALITY V
i
FOR APPLICANT TO FILL IN NEAREST �,
CROSS ST, _
LEGAL
DESCRIPTION LOT NO. � OWNER �j� P7
BLOCK TRACT MAIL -
SIZE OF LOT $-(J rU NOVJOON LOTS
CITY TEL'. NO.
USE OF `
BUILDINGS. DISTRICT NO.
.IBK f -
CONTRACTOR � GROUP MAP PG
f
ADDRESS f, , rG ` - CONNECTION DATA
CITY TEL. NO. STATION - DEPTH
..� ✓/ STATE- MANHOLE REFERENCE
REGISTRATION NO. . / J3 ❑ COUNTY UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
NO. I DESCRIPTION OF WORK FEE Y. CUR - P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER '@ $ 3:50 ,r
HOUSE SEWER CONNECTING_ TO
_ PRIVATE DISPOSALSYSTEM1.00
CONNECT ADDITIONAL BLDG. OR / Gd CO. IMP. NO. JOB. NO.
JWORK.TO HOUSE SEWER 1.00 _L
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO, ROAD PERM.IT NO.
DISCONNECT AND ABANDON SEWER _ STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM - 1.00 PERMIT NO.
SEPTIC TANK',SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL '
SPECIAL CONDITIONS ONLY 2.00 CHARGES -
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE C%G REIMBURSEMENT FEEI HAVE
TRACTORTTOS DATE CONNECT THECTED ABOVEWITH THE DESCR BED EXISTING DWELLING APPROVALS DATE INSEE-C-1 •SISIGNATURE
TO-THE PUBLIC SEWER
SIGNED THIS19
L—DAY OF NEW HOUSE SEWER
-
OWNER OR CONNECT ADDITIONAL - -
OWNERS AGENT BUILDING OR WORK
ADDRESS - �j'�,Zd L SEPTIC TANK, SEEP,.PIT(S)
/ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/O, DISCONNECT PLUG AND
R
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ,ABANDON HOUSE AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE"ABOVE
DESCRIBED RESIDENTI 4 PROPERLY-.) - BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑-.CESSPOOLS❑
SIGNATURE
OF.PERMITTEE
IM
WILLIAM J. FOX.COUNTY ENGINEER VALIDATION
DEPUTY - _ •` "^ -DEPUTX
BY BY
i�%G` ® DEPUTY - _(�EpUTY