HomeMy WebLinkAbout2924ATbA642U CE 808A 9/77 APPLICATION PERMIT
SEWER - SEWAGE
DISPOSAL
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
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Citation
TYPE OF CONNECTIO LENGTH FROM
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ADDRESS 1 ( ( 1 a6
Y. CURB P.L M.L. TO P.L.
P.C. NO.
JOB NO. 3a
CITY Tustin TEL. NO. 1-04
CO. IMP. NO.
LEGAL []
TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO. J
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31677
AFFIDAVIT I WAIVER I EASEMENT RECORD. INSTR. NO. DATE
BLOCK TRACT
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT
HWY. OR ST, WIDENING
USE OF
BUILDINGS
STATE ENCROACHMENT
PERMIT NO.
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INDUSTRIAL
CONTRACTOR
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CHARGES
ADDRESS ®
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CONNECTION CHARGE FEE
G ITY TEL. NO.
STATE [ LIC.
6g
REIMBURSEMENT FEE
LICENSE NO. 26z CLASS A
2.62369
NO.
DESCRIPTION OF WORK FEE
APPROVALS
DATE
INSPECTOR'S SIGNATURE
HOUSE SEWER CONNECTING TO
@
PUBLIC SEWER
NEW HOUSE SEWER
SEPTIC TANK, SEEPAGE PIT OR
@
PITS AND/OR DRAINFIELD
CONNECT ADDITIONAL
BUILDING OR WORK
HOUSE SEWER CONNECTING TO @
SEPTIC TANK, SEEP, PITISI
AND/OR DRAINFIELD
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG. OR @
WORKTO HOUSE SEWER
OVERFLOW SEEPAGE PIT. DRAINFIELD
CESSPOOL ❑ DRYWELL ElEXTN.,
CESSPOOL, DRYWELL, MANHOLE'
ALTER, REPAIR OR ABANDON HOUSE @
ALTER, REPAIR, SEWER OR
SEWER OR DISPOSAL SYSTEM
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS ❑
SEEP. PIT(S) ❑ CESSPOOLS ❑
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OWNER'S issuance Fee S !3
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A T.I'Ibl RIZATI®N T®TAL FEE
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
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 I AM THE LEGAL OWNER OF, AND INTEND TO RE-
SIGNED THIS DAY OF 9 _
SIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY.
OWNER OR
OWNERS AGENT
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ADDRESS
OF PERMITTE (
VALIDATION
CK. M.O.
CASH
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