HomeMy Public PortalAbout9110 LAS TUNAS DR_Sewer__ TEMPLE CIT
ORS088.89 APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 11TSNI
S
ADDRESS AA
AD �s
Af
JOHN A. LAMSIE, County Engineer i
CASSATT D. GRIFFIN, Supt of Building LOCALITY
mg NEAREST
FOR APPLICANT TO FILL IN CROSS,ST. .
LEGAL
DESCRIPTION LOT NO, OWNER O e
MAIL
BLOCK TRACT 39� S~' ADDRESS 410,
z k w /
NO.OF BLDGS. / ./
SIZE OF LOT z�J A' NOW ON LOT CITY a /� Y TEL. N0.
USE OF -w pme --- z
BUILDINGS / C DISTRICT N0. GROUP 'MAP PROCESSED BY
7 BK PG
CONTRACTOR / D - go
ADDRESS CONNECTION DAT
CITY77 TEL.NO. 7/ STATION DEPTH
/f ❑ STATE MANHOLE REFERENCE
REGISTRATION NO. / .�9�e P �S / ❑ COUNTY �L �Q LOWER
NO.' DESCRIPTION OF WO K FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ .00 TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.L.TO P.L. .
PITS.AND/OR DRAINFIELD @ $
OVERFLOW SEEPAGE PIT,DRAINFIELD
W
EXTN..CESSPOOL,DRYELL - @ $ .00
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $ 00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER. @ TRUNK PERMIT N0. ROAD PERMIT N0.$ .00 i
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT -
SEWER OR DISPOSAL SYSTEM @ $ .00 PERMIT NO.
INDUSTRIAL - - -
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE,
AUTHORIZATION TOTAL FEE 7 REIMBURSEMENT FEE
1 HAVE`ATTHIS DATE A CONTRACT-WITH THE HEREIN NAMED CON-
TRACTOR"TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECCTOl�R'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS I)AY OF 19f� NEW HOUSE SEWER �.-
OWNER OR CONNECT ADDITIONAL e
OWNERSAGENT BUILDING OR WORK
ADDRESS � iA-f -s m r SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD -
1 HEREBY CKNOWLEDGE. THAT I 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 A'LTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY A STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I M THE LEGAL OWNER HE ABOVE
DESCRIBED RESIDENTIA R RTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP.PIT(S) CESSPOOLS ❑ - '
OF PERMITTE
®°
CALMATION ROBERT A. WOOD
It.o; 'CASH, SUPERVISING MECHANICAL ENGINEER
2 5..1.0,; 0 7.0-0-
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