HomeMy Public PortalAbout9100 LAS TUNAS DR_Sewer__ zD
saE.889 it-DD - APPLICATION FOR PERMIT
5 8 E 1
'DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1
Deportment of County Engineer
County of Los Angeles BUILDING /Q O r�'�
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY � ���,
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. ,P i-4 JL!l n _
LEGAL
DESCRIPTION LOT NO _ � OWNER )& �MAIL
BLOCK TRACT J � ADDRESS
NO. OF BLDGS
SIZE OF LOT Q0 NOW ON LOT CITY TEL NO
USE OF DISTRICT NO GROUP MAP
BUILDINGS
BK PG
CONTRACTOR �'
� DD/AA7- p �/ �+ CONNECTION DATA
ADDRESS '`7� '-•L A14 / C,&01/4
STATION DEPTH
CITY TEL. NO. �Q ,7.? V MANHOLE REFERENCE _ _ UPPER
1!171°J_ .Er STATE
REGISTRATION NO. [3 CO
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECT?
LENGTH FROM 0
PUBLIC SEWER @ $3 50 Y• CURB �L M L TO P L /40
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. N0.
EXTN ,CESSPOOL,DRYWELL,MAN HOLE @ $2 00 CO IMP. NO X Xm JOB NO
3
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS tDATE INSP TOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER 4 n 15
SIGNED THIS �DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT ��A/�
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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑.
SIGNATURE 19
SEEP PIT(S) ElCESSPOOLS 1 (Z 51
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD, CHIEF PLBG.-INSPECTOR
CK. M. 0. ASHD L&4-036V; JAM10 4 -450 �