HomeMy Public PortalAbout9655 LAS TUNAS DR_Sewer__ V DEPAIK'MENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICAT'" lel
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING f o- NEAREST
ADDRESS r CROSS ST.
f —
LOCALITY DISTRICT NO, SERIAL NO. PERMIT NO.
NEAREST -- — —^ A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS _ USE ZONE i OCCUPANCY MAP
BK PG
CITY TELAO,
CONTRACTOR
—— CO.IMP.NO.
ADDRESS
-- — JOB NO. _—
CITY TEL.NO" TRUNK PERMIT N0.
STATtEr
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. ° _ STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT tt, INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT i NO.OF NOW ON LOTS _
>' _ CHARGES
USE OF r
BUILDINGS r CONNECTION CHARGE FEE
NO.) DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO — REIMBURSEMENT FEE
PUBLIC SEWER 3.50 TO RECEIPT N0. UATE BY
HOUSE SEWER CONNECTING —�
PR":NATE DISPOSAL SYSTEM 1-00 _ -h-.
CONNECT ADDITIONAL BLD&,OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER-0R-REPAIR EXISTING NO. 4 DATE BY
SEWER OR DISPOSAL SYSTEM 1..00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 _ MANHOLE REFERENCE+
PZR LOWER
—.— TYPE OF CONNECTION :ENGTH FROM
OWNERS PERMIT $ OA
Y. CURB P.L. M.L.TO P.L.
1
AUTHORIZATION TOTAL FEE -
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS iNSPECTQR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS. ...-DAY OF. ........_....I4..:�._' NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.-.......... __. ..-.-_......... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS---.._:.--_._.._.._...-----'---`.................._......- AND/OR DRAINFIELD
! HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Ej 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 REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER _
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S)Ej CESSPOOLS
OF PERMITTEE_..,-.:,...- --.-..---------............ ------------.._.....
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