HomeMy Public PortalAbout9042-9046 LAS TUNAS DR_Sewer__ 24650 INSERTS
76AS4 D60 APPLICATION FOR PERMIT
COUNTY OF L03 ANGELES 8A84�n SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING
ADDRESS
. LAMBIE, County Enq�neer
Wm
A. JENSEN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER k710j U r
DESCRIPTION LOT N0.
BLOCK TRACTMAIL
ADDRESS
NO OF BLOCS. '
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE DISTRICT NO. GROUP MAP ROCE BY
BUILDIDI NGS
BK PG
CONTRACTORS
ADDRESS /r) VV VVV CONNECTION DATA
CITY �•4� L N0. S STATION DEPTH
REGISTRATION NO gSfATE
COUNTY MANHOLE REFERENCE UPPER
LOWER
No I DESCRIPTION OF W RK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 TYPE OF CONNECTION LENGTH FROM
PETS AND/OR DRAEINFPTIC TANK, GE DIT OR @ $3 00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
CO IMP. NO. JOB N0, y,
PRIVATE DISPOSAL SYSTEM @ $1 00 W
CONNECT ADDITIONAL BLDG.OR @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER
SEWEFr
ER OR DASPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT pQq
PERMIT NO. F
INDUSTRIAL V
WASTE APPROVAL w
CHARGES V)
OWNER'S PERMIT i 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 3 1 C-D REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEREINCON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWN T BUILDING OR WORK
'7EPTIC TANK,SEEP.PIT(S)
AD AND/OR DRAINFIELD
JI-VERIff ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION
A ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNI THAT I THE LEGAL OWNER OF THE ABOVE
DESCRIVT RESID N A OPERTY. BACKFILL SEPTIC
TANKS
❑
SEEP.PIT(S) ❑ CLS [ISIGNAT 4 f
OF PER
®' VALIDATION ROBERT A. WOOD
CIL M.o. CASH SUPERVISING MECHANICAL ENGINEER
,;�2 6 0 5 SEP 1 3 1 C, D 3 .0 k-) %n