HomeMy Public PortalAbout9106 LAS TUNAS DR_Sewer__ �- 2465INSERTS J
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APPLICATION,. FOR PERMIT 1
�sas42D azo COUNTY OF LOS ANGELES1
SEWER—SEVIJAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER-
BUILDING AND SAFETY DIVISION ;BUILDING /
ADDRESS C7
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITY
,NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT NO. -
BLOCK TRACT / .MAIL
,� C/ � ADDRESS �C� .�-
NO.OF BLDGS. - - - -
SIZE OF LOT NOW ON LOT / -CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP ZPESSED BY
�� f E� � BK PG I
CONTRACTOR
ADDRESS Z7 A" CONNECTION DATA
CITY TEL.N0. :STATION 2, DEPTH
e174 2
STATE MANHOLE REFERENCE t UIPPER.
REGISTRATION NO. ,Y COUNTY
NO. I DESCRIPTION OFrWORK FEE
HOUSE SEWER CONNECTING TO dL✓ V L.G�7��a Gni
PUBLIC SEWER @ $3.00 TYPE OF CONNECTIO LENGTH FROM _
SEPTIC TANKSEEPAE PI
PITS AND/OR'DRAINFGELDT OR @ $3.00 Y. CURB .L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN..CESSPOOL, DRYWELL @ $2.00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 'CO.IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ $1.00
SEWER OR
OR ABANDON SYSTEM HOUSE @ $1 00 =STATE ENCROACHMENT Al
PERMIT NO. O
11-
INDUSTRIAL INDUSTRIAL - U
._WASTE W
CHARGES
OWNERS PERMIT g 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE J�Q Ott)
tb c'S-� pL
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 11
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. // � �'
SIGNED THIS DAY F 19_ NEW HOUSE SEWER -16) rt rL1/�"r 1(�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK;SEEP.PIT(S)
AND/OR DRAINFIELD
I .HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑. DRYWELL ❑ '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,.SEWER OR
PLUMBING AND_SEWERS. - SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY HAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RE UI D BY LOS ANG ES COUNT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T AT 1 AM THE LEG OWNE OF THE ABOVE
DESCRIBED RE D T PROPERTY. � BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP..PIT(S) ❑ CESSPOOLS.❑
"
OF PERMIT E
OF VALIDATI� ROBERT A. WOOD
CK. M.o. calx� SUPERVISING MECHANICAL ENGINEER
-
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