HomeMy Public PortalAbout9627, 9627 1/2 LAS TUNAS DR_Sewer__ DEPAIMINIIENT OF COUNTY ENGINEER SEWER---SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
EAREST
ADDRESS I Gc ,{'l ROSS ST.
LOCALITY �I DISTRICT NO. SERIAL NO. PERMIT NO.
.,L
NEAREST A S
CROSS ST. ----
/y,� �R CEIVED BY Ready for Inspection DATE ISSUED
OWNER A/' ` L-_ s) '
ADDRESS MAIL SE ZOM OCCUPANCY MAP
BK PG
CITY TEL.NO.
CONTRACTOR t 10 Iml CO.IMP.NO. ti
ADDRESS r rV, r JOB NO.
CITYjy` uR 7EL.N0. TRUNK PERMIT N0.STATE
`- -
REGISTRATION NO. ! COUNTY ROAD PERMIT NO.
LEGAL ,t��� t�F),!� STATE ENCROACHMENT
DESCRIPTION LOT N0. I PERMIT NO.
BLOCK TRACT 57(, 1 INDUSTRIAL
WASTE APPROVAL �e
SIZE OF LOT N0.OF BLDGS. CHARGES
1 0 C, NOW ON LOT
USE OF
BUILDINGS 2&1 C 4 ' CONNECTIO*CHARGE FEE
NO.1 DESCR TION OF WORK FEE
s HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50f DATE BY
RECEIPT N0.
�---
HOUSE SEWER CONNECTING TO �
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING DATE I BY
SEWER OR DISPOSAL_SYSTEM I.00 N0.
_
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATIONDEPTH �� I
CESSPOOL—DRYWELL '—
SPECIAL CONDITIONS ONLY 2.00 MA E REFERENCE
UP
PER•
TYPE OFF 0111111 I P,L LENGTH PFL FROM
OWNERS PERMIT $ 1 00 IWA6
AUTHORIZATION TOTAL FEE "� �k' �IP�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEWER�j�
SIGNED THIS......2--.....DAY OF...)&?l_................-..19TYj. NEW HOUSE SEWER ;�1f
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...................................................................... _ BUILDING OR WORK
........................_---_---. SEPTIC TANK,SEEP.PIT(S)
ADDRESS-.......
.-----------�--•-----•--•---•------------• AND/QR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEREDDISCONNECT AND
PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- _
USE SEWER
ER OF THE ABOVE DESCR ESIDENTI L PROPERTY. BACKFILL SEPTIC TANKS I]
SEEP.PIT(S)[:] CESSPOOLS
SIGNATURE 4Z4'
OFPERMITTEE. ---•-•=-=-•-•----...._.._.•..- ------•----•---..-......__-....-
76A642A 663 7/53