HomeMy Public PortalAbout9028-9040 LAS TUNAS DR_Sewer__ ` /�j r
EGOS 12-°3
6A 6420 APPLICATION' FOR PERMIT
I
COUNTY OF LOS ANGELES SEWER-SEWAGE DIrSPOS L
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FARDE79-9,05/0BU'L lA /RSJOHN A. LAMBIE. COUNTY ENGINEER h.
COLEMAN W. JENKINS. SUPT. OF BUILDINGFOR APPLICANT TO FILL IN EAREJ (/L
LEGAL t F L Ei�/G �/ !/
DESCRIPTION LOT NO v - OWNER
577
MAIL /�
BLOCK TRACT ADDRESS `5 / 7Q
SIZE OF LOT NOWNO OON LOTTS� CITY TV' NO. ""(O / LJ 1
USE OF r
BUILDINGS A G �j�/4 Li DISTRICT NO GROUP MAP PROCESSED BY
SK PG
CONTRACTOR i C,�� /I�6 /�/L! i r - / — �
ADDRESS SIV, 1414 L/V U-r(r,g D": v - CONNECTION DATA
CITY �J/ TEL NO 0?C66 `"- �-b STATION `� DEPTH
SL Lic OF /
/CENSE NO ! O CLASS MANHOLE REFERENCE _39 AllUOWE
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO O� Y CURB L M L TOP L
PUBLIC SEWER @ $5 00
SEPTIC TANK,SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD $1000
CO IMP NO .10B NO
HOUSE SEWER CONNECTING TO >
PRIVATE DISPOSAL SYSTEM Q $300 TRUNK PERMIT NO .� ROAD PERMIT NO �� d
CONNECT ADDITIONAL BLDG ORgFFIDAV WAIY[R LAS[M[XT RECORD INSTR NO DATE CC)
WORK TO HOUSE SEWER @ 5300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE Q $500 HWY OR ST WIDENING
H
ALTER REPAIR OR ABANDON HOUSE tU
SEWER OR DISPOSAL SYSTEM $3 00 STATE ENCROACHMENT CL
PERMIT NO Cn
Z
INDUSTRIAL
WASTE APPROVAL
OWIT
OWNER'S PERMs z 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE 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, INSPE OR'SSI NATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER ` ,[
OWNERS AGENT_
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP,PIT(S)
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 ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT IH
LEG L OW INTE TO DISCONNECT PLUG AND
RESIDE IN, THE AS D CRIBED ESI I ABANDON HOUSE SEWER
SIGNATURE ClOF PERMrTTEE BACKFILL SEPTIC TANKS /
SEEP PIT IS) [:1 CESSPOOL
VALIDATI JACK R. ALLEN
CK M o CASH SUPERVISING MECHANICAL ENGINEER
p,, 3422210 D 7.00�' cy