HomeMy Public PortalAbout8827-29-31 LAS TUNAS DR_Sewer__ 1.
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78AQ4� APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depmtnent of County Engineer �$p�
County of Los Angeles BUI ADDREssGjj p �� ��.3 J JOHN A.A. LAMBIE, COUNTY ENGINEER S-mON�(9
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY
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FOR APPLICANT TO FILL IN CROSSNEAREST ST. Tris a
LEGAL +1/�r7� 45 '-' OWNER
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT15
ADDRESS
NO, OF BLDGS. ,yI A
SIZE OF LOT NOW ON LOT �c>p.a.li/ CITY �G5✓ TEL. N0.
USE OFDISTRICT NO. GROUP MAP
BUILDINGS
CONTRACTOR c• n/ V (% 9V
ADDRESS Y S� P ��NC 'V- Lys CONNECTION DATA
✓�S rtL Jr7 STATION - DEPTH O
CITY TEL. NO. V I/G T I MANHOLE REFERENCE PL UPPER
049Cqy" '
REGISTRATION NO. / ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
( HOUSEPUBLIEWER @ $3.50 Y. TYPE O-'a=
TIONP L LENGTH FROM / Q
HOUSE SEWER CONNECTING TO /
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD n4 $3.00OVERLOW SEEPAGE PIT, p �}
ELD
EXTNF CESSPOOL,DRYWELLR M AN BOLE r $2.00 CO- IMP. N0, r�J�V JOB NO.HOUSE SEER 7/7/
PRATE DISPOSAL SYSTEMG TO S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.�_ /7 //
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK C (nl HOUSE SEWER $1.00 PERMIT NO. f1C��V
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION
1� REIMBURSEMENT FEE
TOTAL FEE S -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE I NSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,IFI
TO THE PUBLIC
S�SEWER. r� NEW HOUSE SEWER
SIGNED THIg.l��D Y F 192 1G. CONNECT ADDITIONAL
OWNER OR BUILDING ORWORK
OWNERS AGENT SEPTIC TANK,
SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT1 THE LEGAL NER OF THE ABOVE
DESCRIBED RES]DENTIA OPERTY. BEEP FPIT(S)P❑ CESSPOO❑L$ 3�a ;{ )iQ
SIGNATURE
OF PERMITTEE
JOHN A. LLAMBIE. C d UNTY ENGINEER1}LIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
M. O. CASH
4.5 0
;��4 1 6 2 MAR 1,5- 4
APPLICATION FOR PERMIT �
TsweAaO
646 •^
ON OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING�(�3/ �}` ���/
WM.J. FOX. COUNTY ENGINEER ADDRESS Q /YJ JF J
CASSATT D. GRIFFIN, SUPT oP BUILDING LOCALITY Cl 71
FOR APPLICANT TO FILL IN NEAREST
//�� .+ v CROSS STLEG .
DESCRIPTION LOT NO L V Q�< /�j/ OWNER
Le &A'--
BLOCK TRACT MAIL
ADDRESS
SIZE OF LOT NOWOONBLOTS CITY �/ '� TEL. NO.
USE OF
BUILDINGS S DISTRICT NO. GROUP MAP
BK PC
CONTRACTOR // /l / C
— Y� u
ADDRESS 1110 CONNECTION DATA
CITY��y ��'B�/�,EL. NO. ' r6.?��/ STATION DEPTH
STATE MANHOLE REFERENCE /f /yyam LOWER
REGISTRATION NO. �� 31l ❑ COUNTY `r /.Jt�/�/T/�A/nf!'K
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION L NGTH FROM
PUBLIC SEWER 0 5 3.50 Y. CURB P.L. I.I.L.TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR I P C. NO.
WORK TO HOUSE SEWER I.00 CO. IMP. NO. JOB NO
ALTER OR REPAIR EXISTING �.
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. R D PERMIT N0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT \
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEE AG PIT OR
PITS AND/OR DRAINFIELD E .OD INDUSTRIAL
CESSPOOL- DRYW ELL WASTE APPROVAL
SPECIAL CQT:DITIONS ONLY 2.00 CHARGES
PERMIT CONNEC N CHARGE FEE
OWNER'S s o0
AUTHORIZATION TOTAL FEE MBURSEM ENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CO.'- '
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS —DAY OF 19—
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK ,
SEPTIC TANK, SEEP. PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL LIAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER. REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUN AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OW ER OF THE BO\'E ABANDON HOUSE SEWER
DESCRIBED RESIDENTI L PR P TY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. PIT(S) ❑ CESSPOOLS❑
!
OF PERMITTER
ZI/�iV
71APAJ. FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
:JC3 0 4 0 ; X1118 4 2,0 0 in