HomeMy Public PortalAbout9116 LAS TUNAS DR_Sewer__ D
S&E.663 _11.55 APPLICATION FOR PERMIT
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DIVISION OF"BUILDING AND SAFETY ..SEWER, SEWAGE DISPOSAL _
Department of County Engineer /
County Of Los.Angel@S BUILDING - /.
JOHN A.`LAMBIE;COUNTY ENGINEER ADDRESS �. F_ �.Y/I .,.`iG� .'�
¢J CASSATT 0. GRIFFIN, SUP'TOF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CR'S ST. J
LEGAL - - -
OWNER
DESCRIPTION LOT NO.� �+ _ •/rJ /� �•-
MAIL
BLOCK. TRACT- "ADDRESS
CITY TEL. NO.)7—
SIZE OF LOY` NOW ON LOT -�-
USE'OLD IF ` DISTRICT NO. GROUP MAP
.0 IBK PG
CONTRACTOR. v��G' _ � � /�. 4,'* ��� •
ADDRESS CONNECTION DATA
I .
e STATION ,9' J DEPTH I
CITY � Z,- _, - .TEL. NO '7 -3 %,
MANHOLE REFERENCE
' QSTATE .�/- LOWER
REGISTRATION NO. -� �` � e 3 '{� ❑' COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE'.SEWER CONNECTING TO TYPE OF CONNECTIOCURB j LENGTH FROM
J�� , P.L. M.L.TO P.L.
PUBLI C`SEW ER. @ $3.50 Y-
SEPTIC TANK,SEEPAGE PIT OR "
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE"PIT,DRAINFIELD ,� f� ) P. C. NO. -
EXTN:,CESSPOOL,DRYWELL,MANHOLE @ $2.00 "CO. IMP. NO. JOB NO. -
-HOUSE SEWER CONNECTING TO -
PRIVATE-DISPOSAL SYSTEM @ $1.00 'TRUNK PERMIT NO. ROAD PERMIT NO. -
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
--WORK-TO HOUSESEWER Qa $1.00 PERMIT NO. -
ALTER,REPAIR OR ABANAON HOUSE INDUSTRIAL
SEW ER.OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S` PERM 1 00
- REIMB.URSEMENTFEE
AUTHORIZATION TOTAL FEE G `
I HAVE AT THIS DATEA CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'SSIGNAT.URE'
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �.
TO THE PUBLIC SEWER.. - NEW HOUSE SEWER. ��►6 -
SIGNED THIS. DAY OF 193 f
CONNECT ADDITIONAL
"
OWNER, OR =- -• " - BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
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 DISPOSALSYSTEM.
I .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 I AM THE LEGAL OWNER'- OF THE ABOVE -
DESCRIBED RESIDENTIAL PROPERTY. rte s� BACKFILL SEPTIC TANKS[3SIOF PERMITTEE >GNATURE `� i"',1-'II SEEP.PIT(S) C3 CESSPOOLS❑ "
JOHN A. LAMBIE,COUNTY ENGINEER VALIDATIONROBERT A. WOOD.CHIEF PLBG. INSPECTOR
CK. M.O. H -
' LAP :5
4 7 3 6' DEC 2 4 { Q