HomeMy Public PortalAbout9554 LAS TUNAS DR_Sewer__ 76A642D
APPLICATION-'` FOR ■ ERMIY
1' S&E•663 12.54
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
r A CROSS ST.
LEGAL ,A C7 _
DESCRIPTION LOT NO. KJ / OWNER
BLOCK TRACT / MAIL
NO. OF BLDGS. ADDRESS
SIZE OF LOT NOW ON LOT . CITY _ TEL. NO.
USE OF p
BUILDINGS tJ DISTRICT NO. GROUP MAP
y 1h SK PG
CONTRACT O I T -- I1 e.
3
ADDRESS CONNECTION DATA
CITY EL. NO. l STATION � ... DEPTH
STATE `,' ANHOLE REFERENCE
REGISTRATION NO. 1 ❑ COUNTY 1� l LOWE
TYPE OF CONNEC N "4 LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y• CURB P.L'. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $ 3.50 256
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR — CO. IMP. NO, 113 JOB. NO.
WORK TO HOUSE SEWER 1.00 4
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 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL _
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
6WNER°S PERMIT S 1 00
~ AUTHORIZATION TOTAL - REIMBURSEMENT FEE
TRACHA T OR TO DATE CONNECT THEAABOtl DESCRIBE HEREIN
ING
ESNAMED CON-
DWELLING APPROVALS DATE INS'PECTOR'S SIGNATURE
TO THE PUBLIC SEI�,aER�
SIGNED THIS_ l
�CZD F ) NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC.TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 H BY ACKNOWLEDGE THAT 1 AVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND AlE THAT THE ABOVE I ORRECT AND AGREE TO COMPLY
AND
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE' 90VE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP.PIT(S) [ICESSPOOLS
SIGNATURE -
OF PERMITTE
WILLIAM J.FOX, COUNTY E !NEER VALIDATION
'BY
ACO 3 B7 6 3.,� EERY 16 4. 4.5 fl
DEPUTY DEPUTY
:;-BT BY
�'® - DEPUTY DEPUTY