HomeMy Public PortalAbout8843-43 1/4-43 1/2 LAS TUNAS DR_Sewer__ 84.D 169
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S& APPLICATION FOR PERMIT. 1
S 8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles
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JOHN A. LAMBIE. COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILDIN. CALITY (� r
FOR APPLICANT TO FILL IN �/ CROSS ST. /�
LEGAL L G GP LL OWNER `,�.m.lam'
DESCRIPTION LOT NO. /
�L MAIL
BLOCK TRACT ADDRESS `S
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF
BUILOING VY ` DISTRICT N0, GROUP MAP
CONTRACTOR C t v a�, v-- � MK- �G�
ADD S .� �, 5"A
I tVJ / CONNECTION DATA
CI Y a� TEL. NO. 6
STATION 1 DEPTH
' MANHOLE REFERENCE Q _ UPPER
❑ STATE t
REGISTRATION NO. J CJ ❑ COUNTY
No. DESCRIPTION OF MORK FEE '7{
PHOUSE SEWER UBLIC SEWERCONNECTING TO @ $ 3.50 3 S V TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00 �(
OVERFLOW SEEPAGE PIT. DRAINFIELD CO. IMP. NO. v JOB NO.
E%TN.,CESSPOOL,DRYWELL,M AN HOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 YRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITION AL BLDG.OR O YA STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 lJ PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION ITOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THEJDWE�LILNG
NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBEDG DWELLING /I
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS - DAY F19SL CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT—
SEPTIC TANK.SEEP, PITS)
ADDRESS AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT 1 HAVE REAPPLICATION CESSPOOL❑ DRYWELL❑AND STATE THAT THE ABOVE IS CORRECT ANTO COMPLYWITH ALL COUNTY ORDINANCES AND STATEREGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I A ROPERLY S AND/OR ❑ISCONNECT PLUG ANDLICENSED S REOVIRED BY LOS ANGELES DOD STATE OF ABANDON HOPLUGAUSE DER
CALIFORN A. ORHATLEAL WE ABOVEDESCRIBEESIO NTIAL PROPER Y. BACKFILL SEPTIC TANKS❑SIGNATURE EEP. PIT($1 ❑ CESSPOOLS �.>`S'
OF PERMI
JOHN A. LAMBIE, cbUNTY ENGINEER 'VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. U. 0. CPSN
i p o1'5 7. 1OCT 23 4 (�
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