HomeMy Public PortalAbout9657 LAS TUNAS DR_Sewer__ E1663
3&E.669 f9�S5 APPLICATION FOR PERMIT 1
3&E
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depm°tment of County Engineer
County of Loa Angeles BUILDING L ".
;.
JOHN A. LAMBIE. COUNTY ENGINEER —ADDRESS
CASSATT D. GRIFFIN, SUPT of BUILDING `ADDRESS -`
LOCALITY -
_ FOR APPLICANT TO FILL IN GROSS st. � — -
LEGAL ~' f f ✓
DESCRIPTION LOT NO, �; _O`vVNER '�-r::z�l 1.,��tf,��"' r°`� �✓''"J
MAIL
BLOCK TRACT ADDRESS
---` —_ NO. OF BLDGS. CITY
IZE OF `p TEL. N0.
SL_OT `y' _ NOW ON LOT _
USE OF y- DISTRICT NO. _ GROUP i MAP
_BUILDIM.GSF-BUILDINGS _
BK PG
CONTRACTOR✓ / �9''' ,e' �" #' ";.
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CONNECTION DATA
ADDRESS ^' .s.:.-�,v, $ ,i'�y ,r� �"-�'' 6'�=' ---- _=i -✓3 .-�� — �,
CITY_ �.eW _.,L_=`z ,i--� TE N0. STATION DEPTH
.^-.,,;, �X.. ,
z MANHOLE REFERENCES U R
IN— LO ER's
REGISTRATION NO. AI/- ' ❑ COUNTY
Na. DESCRIPTION Or WORK FEE ar
—I --- - - --- ---- - .-- -- TYPE OF CON NE TION ^"<. .
NOUSE SEWER CONNECTING TO Ci LENGTH FROM
PUBLIC SEWER @ Y- CURB IP.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Ga; y
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO,
EX N.,CESS.00L,DRYtSELL,MAN HOI_E (�. $2.00 - CO. IMP. NO_� " JOB N0,
— — - --- --- _ A --
�� HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM_ _ (:c $1.00 I TRUNK. PERMIT NO. ROAD PERMIT N0, T
CONNECT ADDITIONAL BLDG.OR ----_--- STATE ENCROACHMENT _--
WORK TO HORSE SEWER
011 $100 E— �!
—IIALTER, - PERMIT
REPAIR OR ABANDON HOUSE
—
SEWER OR DISPOSAL SYSTEM
SYINDUSTRIAL----`—— WASTEAPPROVAL.
m CHARGES
i
-----_—_._.-.— —__—= CONNECTION CHARGE FEE
OWNER'S PERMIT ----_.--- — ---- --- --
AUTHORIZATION TOTAL--
� + � I� oo REIMBURSEMENT FEE
APPROVALS DATE I NS P E;C 1O R'S$I G N AT U RE
1 HAVE AT THIS DATE CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER I
rte,- -
SIGNZ.D THIS -- # DAY OF - r 19x5,/ T ADDITIONAL
D ------
r�/ 36 +' CONNECT ADDIT ONAL-
OWNER OR '1� + f" r BUILDING OR WORK j
OWNERS AGENT `� y ,. s ,q ,�1 .; .E/✓,ice
� SEPTIC TANK,SEEP.PIT(E)
AD DRF SST_.._ AND!:OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION LESS POOL❑ DRY ELL IJ
AND STATE THAT THE ABOVE IS CORRECT AND AL-.RCE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE.-LAWS. REGULATING ALTER,REPAIR,SEWER OR {
PLUMBING AND SE,'ERS. SEWAGE DISPOSAL SYSTEM
' HE F9Y CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
SDISCL`NN£C7 PLUG AND
ABANDON HOUSE'SEWEP. _--- _ '-_.---
LICENSED S 'I AM
LOS 'FEES AM THE LEGAL OWNER OF THE ABOVE _-
CALIFORNIA OR THIA tll ANGELES COUNTY AND STATE OF
DESCR}BED.RES D:NTIAL PROPERTY BACKFILL SEPTIC TANKS DSIGNATURE SEEP. PITS) (] CESSPOOLS I
OF PERMITTEE '
1OHN A. L.AMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PL.BG. INSPECTOR
GES. M.0. CASH
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