HomeMy Public PortalAbout9117-9119-9121 LAS TUNAS DR_Sewer__ 16A642D - APPLICATION, FOUR PERMIT
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S&E-669 111.55 '
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE ,DISPOSAL
Deportment of County Engineer
Gouty Of Los Angeles BUILDING - -
` JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN,-SUP'T,OF BUILDING LOCALITY
FOR APPLICANT TO PILL IN CROSS s.
LEGAL. .. OWNER J
DESCRIPTION -� LOT N0.' ,�
,MAIL
BLOCK TRACT /6 -de - ADDRESS
r• -
NO. OF BLDGS. CITY ^ TEL. NO., -
SIZE OF LOT� .� V.,-4,"W ON LOT t
USE OF ?- .�a
BUILDINGS DISTRICT NO: GROUP MAP
_
- BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS 71
l
CITY EL. NO.. STATION _ - DEPTH
MANHOLE REFERENCE., ;.,
`� ATE v LOWER' .
. REGISTRATION O. 163 D ❑ COUNTY "
NO. DESCRIPTION.OF WORK FEE
HOUSE SEWER CONNECTING TO t
TYPE OF CONNECTIO .LENGTH FROM
'Y, . P.lr.
CURBM.L. TO P.L. ��
,. PUBLIC SEWER @ $3.50 ^� _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD - @ $3.00
-OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0.
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
O.CONNECTADDITIONAL BLDG.OR. STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ,
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER.OR DISPOSALSYSTEM @ $1.00- WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S: PERMIT S 1 00
- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE S^
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED CON- APPROVALS DATE INS ECTOR:SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING Q
TO THE PUBLIC SEWER. _ NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING.OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE. ABOVE IS CORRECT.AND AGREE TOCOMPLY
-
WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING - ALTER,REPAIR,SEWER'OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM '
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 . S
CALIFORNIA. OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN. 1 PROPS TY. ` S .BACKFILL SEPTIC TANKS❑
.•SIGNATURE -SEEP.PIT(S) ❑ CESSPOOLS_+�1
.OF..PERMITTEE - '. _
JOHN A. LAMB IE.'COONT .ENGINEER VALIDATIC Ijh' ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
...i..., CK. 11.0. ASN
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