HomeMy Public PortalAbout9082 LAS TUNAS DR_Sewer__ 76AG420 APPLICATION FOR PERMIT 1
8&E-889
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
- County of LOS Angeles BUILDING �O (y�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS a
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0. OWNER�I
BLOCK TRACT MAIL 0 ADDRESS -4 44 4A404 t
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS � j B /K PG
� I S
CONTRACTOR '/
CONNECTION DATA
ADDRESSIA
(C_
CITY TEL. NQS
STATION V DEPTH
MANHOLE REFERENCE _ PER
ATE L
REGISTRATION NO ❑ COUNTY
NO. DESCRIPTI N OF WORK FEE
TYPE OF CONNECTIO LENGTH FROM ,r
HOUSE SEWER CONNECTING TO Y. CURB P.L M.L.TO P.L. !
PUBLIC SEWER @
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO. IMP NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $100 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON, APPROVALS DATE INSPECTOR SSIGN . URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - -
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT
� � SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW D
CALIFORNIA OR THAT 1 AM THE LEG OWNER OF E ABOVE
ER
DESCRIBED RESIDENTIA PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERMITTEE
JOHN A LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A WOOD, CHIEF PLBG INSPECTOR
- CK EE O CASH - - -
1 u; FM g 1 0 s 5.00 N