HomeMy Public PortalAbout9445 LAS TUNAS DR_Sewer_10/16/1974_connect sewer c_ C�� .
76A 642D-CE808-10-71 APPLICAT10 FOR PE�,F�MIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �—
ADDRESS
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ^
DESCRIPTION LOT NO. `7jy OWNER /
MAIL '
BLOCK - TRACT ADDRESS (/
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY ?�ea Cly TEL. NO.
USE OF - DISTRICT N0. GROUP MAP . PRO ESSED BY
BUILDINGS iy✓�.
- BK pG
CONTRACTOR
ADDRESS 2w CON/^N�ECTION DATA
CITY TEL. NO._
_y P� j�Y STATION y _ DEPTH
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STATE �� LIC ^ MANHOLE REFERENCE UPPER
LICENSE NO. CLASS (� ` 6'�•� ✓ 66O.% }{-
NO. -DESCRIPTION OF WORK FEE TYPE OF CONNECTIONLENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P:L. M.L.TO P.L.
.PUBLIC SEWER @ $7.00 -
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
CO. IMP. NO. / JOB NO.
PITS AND/OR DRAINFIELD @ $10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d
PRIVATE DISPOSAL SYSTEM $3.00
/ CONNECT.A.QP44- lFn'CBLDG.OR AFFIDAVIT WAIVER -EASEMENT RECORD. INSTR.NO. DATE O
OUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD O
EXTN..CESSPOOL,DRYWELL. @ $5.00 HW V.OR ST.WIDENING L
ALTER.REPAIR OR ABANDON HOUSE V V
SEWER OR DISPOSAL SYSTEM @ $3.00 L)
STATE ENCROACHMENT _
MANHOLE @ $7.00 PERMIT NO. d
ry N
INDUSTRIAL ,-_ Z
WASTE APPROVAL fl
OWNERS PERMIT s s 00 CHARGES
AUTHORIZATION I TOTAL FEE /1 /I CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTORTO 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 p �
ADDRESS BUILDING OR WORK V/ f
SEPTIC TANK.SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL Cl DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES CO NTV AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT AM TH EGAL W OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A V D D I NT OP TY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP.PIT IS) ❑ SSPOOLS ❑
VALIDATION CK. M.O. CASH
36a CiC 1� 1u .0 6.004E13