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Home My Public Portal About9080 LAS TUNAS DR_Sewer__ C -62 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS oS fVC WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN [CROSS ST. LEGAL j DESCRIPTION LOT NO. OWNER . MAIL BLOCK TRACT (�,+J ADDRESS SIZE OF LOT G NOW ON LOT (,/ CITY ,.� TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDNS K PG IG B CONTRACTOR ^ ADDRESS rs V CON ECTION DA CITY TEL. NO. TA STATION DEPTH �}-{I STATE UPPER REGIS. ATION NO. LJ COUNTY MANHOLE REFERENCE LOWER NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM - ^� HOUSE SEWER CONNECTING TO Y. CURB .L. M.L.TO P.L. PUBLIC SEWER @ $5.00 p.C.NO. SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB NO. :PI AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO N ROAD PERMIT NO. - PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG,OR AFFIDAVIT I WAIVER EASEMENT I DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 �9RABANDON HOUSE HWY.OR ST.WIDENING _ SEWER Ii& ..«KM @ $3.00 ( STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ 21 00 CHARGES CONNECTIO HARGEFEE AUTHORIZATION TOTAL FEE _ 47� 1 HAVEAT THIS DATE A CONTRACT WITH THE HEREIN NAMED CO N. RE URSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, APPROVALS DATE INSPECTOR'S SIGNATURE SfGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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 ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM '!HE LEGAL OWNER OF AND IN D TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBE RESID - L PE ABANDON HOUSE SEWER SIGNATURE /y OF PERMITTEE_ rl. W' BACKFILL SEPTIC TANKS El SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATIO ROBERT A. WOOD CK. M.O, SUPERVISING MECHANICAL ENGINEER CASH L�t;1,01 y 4110 j 1 I 5.0 0 S&E-66 APPLICATION FOR PERMIT '� 1 8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL y Dep=tment of County Engineer County of Lob Angeles ADDRESS AD 0< �7 CISF � JOHN A. LAMBIE, COUNTY ENGINEER ® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO OWNER ;' MAIL BLOCK TRACT IS D S- ADDRESS 6) or .4,64 N0.OF B •r' L SIZE OF L NOW ON LOT CITY�/ !"•� TEL N0. USE OF BUILDINGS DISTRICT NO. GROUP MAP . �= BK PG CONTRACTOR L jv ADDRESS S, CONNECTION DATA 4::_ STATION DEPTH , CITY y, ,aX TEL. NO. ► 0 MANHOLE REFERENCE J- UPPER ❑ STATE T P R REGISTRATION NO. ❑ COUNTY _ p NO. DESCRIPTION OF WORK FEE , HOUSE SEWER CONNECTING TO TYPE OF CONNECTIOP. _ LENGTH FROM PUBLIC SEWER @ $3.50 Y• CURB M.L.TO P.L. �D T SEPTIC TANK,SEEPAGE PIT OR •�w�_� �N �`�`/)— �r �� 4_I PITS AND/OR DRAINFIELD Q $3 00 t /� OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. JOB NOO EXTN ,CESSPOOL,DRYWELL,MAN HOLE Q $2 00 37 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM Q $100 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG OR / STATE ENCROACHMENT WORK TO HOUSE SEWER Q $1 00 / PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE , INDUSTRIAL SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT S 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS ATE 1NSPECTOR•SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I TO THE PUBLIC SEWER 19 NEW HOUSE SEWER °� _ Alta SIGNED THIS �' DAY .JZG%' CONNECT ADDITIONAL OWNER OR BUILDING OR WORK � _ OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND 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 DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ SIGNATURE �/,/ • SEEP PIT(s) Ll CESSPOOLS .A.«- OF PERMITTEE /! JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR wc`, � 4 2 4u HPRS 4 5.50 r