HomeMy Public PortalAbout9420 1/4, 9420 1/2,9420 3/4 LAS TUNAS DR_Sewer__ APPLI:CATION '* FOR
PERMIT
'•*6&E•663 12.54 1'
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE, DISPOSAL
Department of County Engineer
BUiLDIN
County of Los Angeles ADDRESS ���� 1 x - 41'4-
I
WM.J. FOX, COUNTY ENGINEER
Razffffijad§�B am=
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLIgANT TO-FILL. IN __ NEAREST
- CROSS ST.
DESCRIPTION LOT N0. .`.d'' .(�^��� OWNER
BLOCK TRACT' �o��� ' MAIL
_
✓' NO. OF BLDGSy/�1��_ ADDRESS
SIZE OF LOT 4,.j. x y C) NOW.ON LOT L/�� CITY TEL. NO.
_USE OF .
BUILDINGS - DISTRICT NO. GROUP MAP
CONTRACTOR C �� I ,'�J ��• BK A7
_ 1 "
ADDRESS c. .jam ,4 .//8'J J-4.) CONNECTION',DATA
CITY �R+,�" TEL. N01d/r,����d�' STATION
J /? ❑ STATE MANHOLE REF'Ei�EtJCE *"
REGISTRATION.NO. / 4 ❑ COUNTY UPPER HI }fib,, ," - LOWER
-� - TYPE OF"CONNECTION &AZiH.FROM _
NO.' •DESCRIPTION OF WORK FEE Y. CURB P.L. IA•.L'.7-T6-P.L.
HOUSE SEWER CONNECTING TO T- G
PUBLIC SEWER $ 3.50 _'50
HOUSE SEWER CONNECTING TO /- 14-—r- `AW ZE-1
_ PRIVATE DISPOSAL SYSTEM 1.00 (� 9
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. / �i �,Gd08.
WORK TO HOUSE SEWER 1.00 Jam_
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM ' :1,00' - TRUNK PERMIT NO. ROAWPERMIT NO.
DISCONNECT AMD ABANDON SEWER STATE ENCROACHMENT �—
_ .AND/OR DISPOSAL SYSTEM '1.00 PERMIT N0. -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD `~ 2.00 INDUSTRIAL _„�..---•^'•�
CESSPOOL- DRYW ELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNER'S 5�� /�L %��
. .1 _ 00._
AUTHORIZATION '' -.TOTAL TEE. - f�' -
TRACTORHAVE TTOS CONNECTDATE ONTRTHEA ABOVECTED WDESCR BEDITH THE HEREXISTINGAMED DWELLING APPROVALS DATE INSP CTOR•S SIGNATURE
TO THE PUBLIC SEWER -
SIGNED THIS DAY OF / 19— NEW HOUSE SEWER2
OWNER OR �� ry,i/� '/ �-��l rC•�•(„ CONNECT ADDITIONAL -
OWNERS AGENT YYY"' JBUILDING OR WORK
- SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD •�.�+•--
I HEREBY ACKNOWLEDGE THAT I 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
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❑
// SEEP:-PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
`Y�3 6 0 'S-- MAY 1.1 4 4.5 0 n'
BY BY _
DEPUTY DEPUTY
�:�tCo 3:6 0 54-)1. t y 1'1 s 1 0.0 0 �,
BY BY �//�s/� �'''`
,.`,® DEPUTY / ry DEPUTY�y