HomeMy Public PortalAbout9445 LAS TUNAS DR_Sewer_10/16/1974_connect sewer (2) 76A 642D -CE808-10-71 APPLICATIOPVJ OR PE
COUNTY OF LOS ANGELES SE. ER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY. DIVISION F.R..S
{f j
FOR APPLICANT TO FILL IN
LEGAL
DESCRIPTION. LOT NO. ` OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY �� � TEL, NO. '
USE OF DISTRICT NO. GROUP MAP PRO SSED BY
BUILD INGS E• L� �✓f:IL/' BK PS
CONTRACTOR
ADDRESS CONNECTION DATA
STATION DEPTH
CITY' ✓ &!TEL. NO.�7 —
STATE �7 O� ,, L 15,OLA55 , I' UPPER
MANHOLE REFERENCE l/J��� ��2 6AMRR-
LICENSE NO. _/ 'i rJ
NO. .DESCRIPTION OF WORK FEETYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P.L.
PUBLIC SEWER C $7.00
SEPTIC TANK.SEEPAGE PIT OR P.C.N0.
CO.IMP. NO. JOB NO.
PITS AND/OR DRAINFIELD @ $10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. }
PRIVATE DISPOSAL SYSTEM @ $3.00 _
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -EASEMENT RECORD.INSTR.NO. DATE O
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD pC
EXTN..CESSPOOL.DRYWELL. @ $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT V
MANHOLE PERMIT NO. a
@ $7.00 - co
INDUSTRIAL ,�q�y '
q=}�� WASTE APPROVAL V��A- �-n 17-7¢' Z
OWNER'S -00 CHARGES A
AUTHORIZATTOTAL FEE CONNECTION CHARG EE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE �-
OR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TRACT
TO THE PUBLIC SEWER. APPROVAL DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR -.NEW HOUSE SEWER
OWNERS AGENT
- CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK
Y
SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING "V
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1HEREBY CERTIFY THAT I AM PROPERL REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REOUI BY L 5 ANGLES Y AND STATE OF .SEWAGE DISPOSAL SYSTEM �nNI I
CALIF0 RN IA OR TH 1 AM T EGA ER D INT NO TO DISCONNECT PLUG AND �� \ U
RESIDE IN, THE A OV D ED I PR ABANDON HOUSE SEWER
SIOF ATURE
PERMTTTEE BACKFILL SEPTIC TANKS ❑ V
SEEP.PIT(S) ❑ SPOOLS ❑
VALIDATION CK. ' M..0. CASH