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HomeMy Public PortalAbout9445 LAS TUNAS DR_Sewer_6/7/1974_house sewer or disposable system 2/70 76A6A 642 D APPLICA ON FOR P RMIT - 6 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILD IN JOHN A. LAMBIE, COUNTY ENGINEER AooRESS� ,S S COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY r-1 `✓ NEAREST FOR APPLICANT TO FILL IN CR05S ST. (PRINT.OR TYPE ONLY) LEGAL Ut .DESCRIPTION LOT NO. OW NER MAIL BLOCK TRACT ADDRESS NO OF BLDGS. / ' SIZE OF LOT N ON LOT ( CITY TEL. NO. USE OF DIS TRICT NO. �U�CLASS MAP PRO ESSED BY BUILDINGS IL8K f� J PG CONTRACTOR �n94 ADDRES 1 \-/ (J -C. NNECTION DATA CIT _TEL. NO. �STZTE LICyJL� STATION DEPTH �9 LICENSE NO.: 7���, CLASS CI Y/jam MANHOLE REF ERE NCJE 7 UPPERS NO. ,DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM 7 HOUSE SEWER CONNECTING TO Y. CURB .L�.'> M.L.TO P.L, PUBLIC SEWER @ $5.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT'NO. PRIVATE DISPOSAL SYSTEM @ S3.00 d CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER I-EASEMENT RECORD. INSTR.NO. DATE O WORK TO HOUSE SEWER @ S3.00 U OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CE5SPOOL.DRYWELL.MANHOLE @ $5.00 HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE O ©� 0 SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT U PERMIT NO. W a - INDUSTRIAL - WASTE APPROVAL Z CHARGES OWNERS PERMIT S 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER ' OWNERS AGENT CONNECT ADDITIONAL - BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACK E THAT I HAVE READ THIS APPLICATION, AND/OR DRAINFIELD ' AND STATE T THE AB E IS CORRECT AND AGREE TO COMPLY WITH ALL OUNTY ORDINI NCES AND STATE LAWS REGULATING CESSPOOL [:1 DRYW ELL ❑ PLUMBING AND SEWERS. ) - I HER Y CERTIFY THAT/1' AM PROPS STEREO AND/OR ALTER,REPAIR,SEWER OR LICENSE AS REQUIRED BAY LOS S COUNTY AND STATE OF SEWAGE D ISPOSAL SYSTEM CALIFOR IA OR jE'lAO T I AM THE EGAL''OWNER OF, AND INTEND TO DISCONNECT PLUG AND 7 �Q RESIDE I . THEVE•`DESCR ED R 514 ENTIAL PROPERTY. -/ '$ABANDON HOUSE SEWER ` �'YSIGNATURE . �! y, / BACKFILL SEPTIC TANKS ❑ OF PERMITTEE �....... ❑ SEEP.PITE3S) CESSPOOLS VALIDATION JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER M.O. .CASH JUN 7 1 U 0 6.0 ® a 0