HomeMy Public PortalAbout9626-9628 LAS TUNAS DR_Sewer__ 9 IZ�-663 3'•RB APPLICATION FOR PERMIT
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DrfISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING ^y; f ��v 15—
M M.J.FOX,COUNTY ENGINEER
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CASBATT G.GRIFFIN,$UP`T OF BUILDING
LOCALITY r Y i e
FOR APPLICANT TO '`ILL IN NEAREST
GROSS ST.. � _
LEGAL
DESCRIPTION LOT NC. 'k-k- �� ,' OWNER � -� 'y.'
BLOCK TPACT '�`-;' / MAIL
ADDRESS
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ADDRESS fir' a 7 C014NECTION DATA
CBTY TEL. NO. STATIONj � DEPTH
REGISTRATION' h0. fT�
- STATE-- MANHOLE REFERENCE
_--ci i_.�te~_(„l LOWER
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ilk'
NO. DE.SCRiPTCON OF WORK EEE --- _
TYPE.OF CONN .CTf y..>._�®—u LENGTH FROM v `
Tr HOU N_ ER CONNECTING TO _ -- --I �; y-,-'" Y. CURB —_ f C„)_ 14.., TO P
1 LBLIC SEWER � S 3.5q
--- ---
HOUSE SEWER CONNECTING 7.0
I PRIVATE DISPOSAL SYSTEM
CONNECT
-
CONNECT ADD;TICNAL BLDG..OR � r � r N0.
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ALTER OR 3 AIR 'XIS NC
CS4_ _- __..-...�_
_J SEWER R DISPOSAL SfSTL 1i i OO I - 3kUNY P5RMiT NO. ROAD PERMIT NO.
_LDISCONNECT AND ABANDON SEWER ---� —
_ AND/OR DISPOSAL SYSTEM`§ ? 00 STATE EI CROHCHMENT -
-- PERMIT NO_
SEPTIC TANX, SEEPAGE.PIT OR
_-_-.
�. INDUSTF aL
CESSPOOL ERY YV LL
E—... .__. WASTE Al�'1#.G W1AI.
I ..! y... -- -• � � .•-�-
i PE('1A rCYDIYIONS ONLY 2-00
- - �- — --'--` I -- C O Id N c C T
,y -CHARGE FEE
WMER'S PERMIT s !
0 01
AUTHORIZATION �TC3TAL FEE � I �x RE0,19LIA-,EMENT
! � - -
i HAVE THIS DATE CO'. R.9C"'ED WITH THE HEREIN NAMED CON- c..
TRACTOR TO CONT/ T TkiE .ASQ'iL DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOWSyIGNATUR �
TO 7HE PUbL[v S ';ER
SIGNED THIS---DAY OF.» _ Ig_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL. - 3
OWNERS AGENT. _ BUILDING OR WOR—K___
..------ .-----� ^� SEPTIC TANK. PtT{S;
AND/CR DRAIN}FI1lL LJ
'. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL L LRY'NELL 0
AND STATE THAT THE ABOY,'- IS CORRECT AND AGREE TO COMPLY
L
COUNTY ORDINANCES AND STATE LAWS REGULATING, ALTER, REPAIR SEWF'R OR �
AND SEWERS. SEWAGE DISPOSAL SYSTEM
Y CERTIFY THAT I AM'. PROPERLY REGISTERED AND/OR ....._`-.-
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
IA C72 ,53AVt .I AM THE LEGAL OW'INER OF THE ABOVE ABANDOS __UiE bEW R
REa ENTIAL PROPERTY BACKFILL SEPTIC TANKS 0 J
', y'"�q „E 5.P PITS) B.., rESSPOOLS'E]_--�.--�-.
E: _ ;�Yf _ V" -- -iITT
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WILLIAM J.FOX.COUNTY ENGINEER tALMATION R.A.WOOD, CHIEF PL.Sa. INSPECTOR