HomeMy WebLinkAbout2925A76A642D CE 808A 9/77 PERMITAPPLICATION FOR
SEWER ® SEWAGE DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY
DIVISION
FOR APPLICANT TO FILL IN
DISTRACT NO. GRRoup MAP PG PROCESSED BY
BK
BUILDING
ADDRESS irdseye Dr.
p
Di and Bar
Diamond
CONNECTION DATA
LOCALITY
NEAREST
STATION `�d DEPTH
/,
CROSS ST.
UPPER
MANHOLE REFERENCE /„
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Builders
Citation Builder
F G" LOWER
OWNER
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TYPE OF CONNECTIO LENGTH FROM
MAIL 17731 Irvine t7 '1 Blvd
ADDRESS d.d..L
Y. CURB P. M.L.TO P.L.
i /
P.C. NO. G`
CO. IMP. NO. JOB NO.
CITY TustinTEL. NO. 731-01,41
LEGAL py
TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. f
31677
=TjAFFIDAVIT RECORD. INSTR. NO. DATE
BLOCK TRACT
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT
HWY. OR ST. WIDENING
BUILDINGS residence
STATE ENCROACHMENT
PERMIT NO.
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& des Constr. Equip.
INDUSTRIAL
CONTRACTOR11hoa
WASTE APPROVAL
P 0. Box 1418
CHARGES
ADDRESS @
CONNECTION CHARGE FEE
CITY TEL. NO. a
STATE rg[ry LIC.
6
REIMBURSEMENT FEE
262 LICENSE NO. CLASS A
NO.
DESCRIPTION OF WORK FEE
APPROVALS
DATE
INSPECTOR'S SIGNATURE
HOUSE SEWER CONNECTING TO
CO
PUBLIC SEWER
!
"
NEW HOUSE SEWER
SEPTIC TANK, SEEPAGE PIT OR
@
CONNECT ADDITIONAL
BUILDING OR WORK
PITS AND/OR DRAINFIELD
HOUSE SEWER CONNECTING TO @
SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG. OR @
WORKTO HOUSE SEWER
OVERFLOW SEEPAGE PIT, DRAINFIELD
CO
CESSPOOL ❑ DRYWELL ❑
EXTN., CESSPOOL, DRYWELL, MANHOLE
ALTER, REPAIR OR ABANDON HOUSE
eO
ALTER, REPAIR, SEWER OR
SEWER OR DISPOSAL SYSTEM
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS ❑
SEEP, PIT(S) ❑ CESSPOOLS El�
O..AYdf�ER'S Issuance Fee s �">�'
1,
AUTHORIZATION TOTAL FEE y
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
9
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
TO THE PUBLIC SEWER.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO RE-
SIGNED THIS. 'DAY OF 9 9 _
SIGNED
IN, THE ABOVE DESCRIBED RESIDENT' jjROPERTY.
OWNEROR
OWNERS AGENT
`i J
SIGNATURE
OF PERMITTEEt.l✓'+✓�
ADDRESS
VALIDATION
CK. M.O.
CASH