HomeMy Public PortalAbout9530 LAS TUNAS DR_Sewer__ D
S&E-669 3.55 APPLICATION .FOR PERPERMITS&E-6
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL -
Deportment of County Engineer
County of Los Angeles BUILDING
ADDRESS L
WM.J. FOX. COUNTY ENGINEER -yam //�'�
T) CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY /�/� �� C,
FOR APPLICANT TO FILL IN NEAREST CROSS
J-4 �_
LEGAL
CROSS ST, /� 7
DESCRIPTION LOT NO. ✓ �I' OWNER ex
BLOCK
TRACT .5 `2-& p DRESSNO OF
SIZE OF LOT Y.S j( ( �� NOONBLOTS
Wl CITY �r�c� �� TEL. NO.(/G ^ G 3
USE OF
BUILDINGS DISTRICT N0. GRR UP BK MAP PG
CONTRACTOR L.Dai./e y 'FJ(f v-0'
ADDRESS /7.7 hqqq yCONNEOCCTION DATA
CITY 9/'Cdd/� TEL. NO. tv- -7"6037 STATION i // DEPTH
I� ❑ STATE MANHOLE REFERENCE •y !� lI'
REGISTRATION NO. 25 J ' ❑ COUNTY / 8�!✓ LOWER
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTI LENGTH FROM 'a
LPUBLIC SEVERHOUSE SEWER CONNECTING TO @ $ 3.50 - Y' CURB P.L� A1.L. TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT
INORKTO HOUSE SEWER BLDG. OR 1.00 _CO. IMP. N0. JOB C.OQ NO.O.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL '
SPECIAL C014DITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
PERMIT
OWNER'S s 1 00
AUTI30RIZATION TOTAL FEE REIMBURSEMENT FEE
I
HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- �s
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSP CTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS I _DAY OF n�or7 t9 % NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT �� BUILDING OR WORK
;X-,)40 � SEPTIC TANK,SEEP. PIT(S)
ADDRESS ND/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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED.BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER I
DESCRIBED RESIDENTf.�O ERTY; BACKFILL SEPTIC TANKS❑ r
SEEP. PITS) ❑ CESSPOOLS
SIGNATURE G/
OF PERMITTEE
WILLIAM J.FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLEIG. INSPECTOR
�r1i;so 6 2 ,2 9 MAY 2 l a 4.5 Ul