HomeMy Public PortalAbout9123, 9123 1/2, 9125, 9125 1/2 LAS TUNAS DR_Sewer__ 7GA642° APPLICATION FOR PERMIT 1
S&E-6613,11-55
DIVISION OF BUILDING AND- SAFETY SEWER SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
ADDRESS c'
JOHN A. LAMBIE, COUNTY ENGINEER
® -CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY /ie
FOR APPLICANT TO FILL IN
NEAREST
ROSS ST.
LEGAL �I .�j,�/ _ OWNER
DESCRIPTION LOT N0. MAIL
.vC dam'
BLOCK - TRACTfO ADDRESS
O. OF BLDGS. CITY TEL. NO. -
SIZE OF LOT NOW ON LOT
USE OF _
BUILDINGS DISTRICT N0. I GROUP� I � MA
-
f.� K
CONTRACTOR
ADDR ESS`5�4zy� CONNECTION DATA
//�y STATION ♦ DEPTH
CI7Y� � 1157/1:51 TEL. NO.av, UPP
y!! •• MANHOLE REFERENCE
REGISTRATION NO.
�y` [:1COU7 TY I ` W R
No. DESCRIPTION OF WORK FEE TYPE OF CONNECTIOI )
HOUSE SEWER CONNECTING TO - LENGTH FROM -
Y- CURB M.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. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO, / Z�q JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.(::� p'
n -1 I_q
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO-HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE _
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE J
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWS NEW HOUSE SEWER
SIGNED THIS DAY19 -CONNECT ADDITIONALR w
OWNER OR BUILDING OWORK
NT -.
OWNERS AGESEPTIC TANK, T
SEEP,PIS)
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 DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ABANDON HOUSE SEW D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS El
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. N.O. CASH
4.5