HomeMy Public PortalAbout9090-9092 LAS TUNAS DR_Sewer__ r'
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CE808 11_57 APPLICATION FOR PERMIT
7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ie
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALITYNEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. may'" OWNER .-
BLOCK TRACT MAIL -
ADDRESS
SIZE OF LOT L Sx d O NOWOONBLOT S -Z CITY TEL.NO.
USE OF
BUILDINGS DISTRICT N I I GROU I IP
CONTRACTOR ) f BK PG
ADDRESS CONNECTION DATA
CITY lyf J/ EL.N0, s STATION —74_413� DEPTH
ATE MANHOLE REFERENCE / UPPE
REGISTRATION N0. COUNTY / R
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO./37 7 JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 ! �+ TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 15r 150 REIMBURSEMENT FEE
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT WITH THE ItNGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. _ p
SIGNED THIS Y OF �! 19�� NEW HOUSE SEWER 1 to
OWNER OR �f /'/ � - CONNECT ADDITIONAL
OWNERS AGENT . ���111 ,.(oC BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)- -- - -- - - - _
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE, THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL El - - ' - - - --
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL S WERSYSOR -- -
1 HEREBY CERTIFY THAT 1 AM- PROPERLY REGISTERED AND/OR - DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER_A _.
CALIFORNIA OR THAT I AM_ THE .LEGAL OWNER _OF THE.ABOVE - - - - - - - -- - ---- -
DESCRIBED RESIDENTI ROPERTY BACKFILL SEPTIC TANKS ❑ I
SIGNATURE SEEP. PIT(S) ❑CESSPOOLS , q�t•,A,�,,..
.... � '
OF PERM]TTE
LIDATION ROBERT A. WOOD
K. •• M.o. CASH SUPERVISING MECHANICAL ENGINEER
3 3 6 2;'r; XL 31 1.p..A 5_:5.0 N._
E-6D
sa ss tt-as
APPLICATION FOR PERMIT 1
s .s
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
_OqoJOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL .97 OWNER
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT SyD S ADDRESS
�- Q N0.OF BLDGS. CITY
SIZE OF LOT �TEI.
O NOW ON LOT
USE
BUILDIOFNGS DISTRICT NO. GROUP MAP PG
BK
J L -
CONTRACTOR /1C /0�
CONNECTION DATA
ADDRESS /
CITY / TEL. NO. STATION DEPTH
MANHOLE REFERENCE PPER
STATE LOWER
REGISTRATION No. �2� ❑ COUNTY /
NO. DESCRIPTI N O�K FEE TYPE OF CONNLENGTH F
CONNECTION
HOUSE SEWER CONNECTING TO Y. CURB P.L.y M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
EXTN.,CESSP00L,DRYWELL,MANH0LE @ $2.00 CO. IMP. NO. !OB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT > 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
APPROVALS DATE 1 NSPEC•TOR'SS 6 ATURE
I HAVE AT THIS DATE A CONTRACT WITH THE EREIN NAMED CON- F _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I �
TO THE PUBLIC SEWER. rr NEW HOUSE SEWER
SIGNED THIS ZY DAppY_�0 ✓t/L 19rSZ CONNECT ADDITIONAL /' U
OOWNER ORWNERS AGENT /7 r '✓ BUILDING OR WORK
SEPTIC TANK,SEEP,PITS) 4, /
ADDRE AND/OR DRAINFIELD
I HE 0 E HIS A Obi CESSPOOL❑ DRYWELL❑
AND 5 A 0 PLY
WITH AL CO.UN ORDIN CES AND STATE L�VS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY ERTIFY HAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED ASC REOUIR D BY INGE COUNTY D T OF
��LIFORNIA OR TH E LE OWN 0 T ABANDON HOUSE SEWER _
DIE Alu Q f EN A BACKFILL SEPTIC TANKS❑
11ylTJJt_fit[�J / ♦ SEEP.PIT(S) ❑ CESSPOOLS
❑
SIG A �U
01 PER ITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION,j ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CK. I O. CASH
( 3163 JUL 241 A 5.50