HomeMy Public PortalAbout9108 LAS TUNAS DR_Sewer__ TEMPLE CITE'
78"862° APPLICATION FOR PERMIT
C11806 8.59COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISIONBUILDING -
ADDRESS c� ✓C! T
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY. P [' �/`
NEAREST
FOR APPLICANT TO FILL IN ceoss ST.
LEGAL 91 ayta+v C.f
DESCRIPTION LOT N0.
OWNER
BLOCK TRACT ' MAIL
ADDRESS / e'7-_S Lt /,
X N0.OF BLDGS.
SIZE OF LOT S NOW ON LOT CITY a NO.
USE OF `
BUILDINGS DISTRICT NO. GROUP BK PG MAP PROCESSED BY
CONTRACTOR > !;Z,r � N/
ADDRESS n s CONNECTION DATAµ V
CITYP TEL.N0. STATION ? �7 _ DEPTH
y^ STATE MANHOLE REFERENCE
REGISTRATION NO. J ® COUNTY LOWER.
NO: j DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $100 TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB L.
M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $ .00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $ .00
HOUSE SEWER CONNECTING T0. P.C.NO. -
PRIVATE DISPOSAL SYSTEM @ $1 00 CO.IMP. NO. A-77 JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $ .00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ .00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERF $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON-
TRACTOR TO CONNECT THE.ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC
SIGNED THIS ` DAY OF 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS �. SEPTIC TANK;SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGETHAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ f
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 AM THE LEGAL OWN OF THE ABOVE
DESCRIBED RESIDENT PgPERTY. SEEP.FPIT(S)ILL TIC LSP CESSP00
❑ ❑ ❑
SIGNATURE
OF PERMITT
®r , LMATION ROBERT A. WOOD
G!C H.C. CASH SUPERVISING-MECHANICAL ENGINEER
:1*25 1.0. 0 7.00- 4