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HomeMy Public PortalAbout9124 LAS TUNAS DR_Sewer__ 76A 642D - CE 08 - 9/73 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 9124 E. La s Tu;2131 LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST. Loma CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER Raph Weaver M"" 9124E Las Tuna BLOCK TRACT ADDRESS E. NO. OF BLDGS. i 28 SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP BUILDINGS 'I,, [�hjBK p5 CONTRACTOR n S tum inY/ 9 ADDRESS 4265 N. Baldwin Ave. CONNECTION DATA CITY El Monte TEL. NO. 443—W78 STATION DEPTH f STATE LIC MANHOLE REFERENCE - UPPER LICENSE NO:. CLASS LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD Q $10.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM Q $3.00 CONNECT ADDITIONAL AFFIDAVIT wAlv[[ [�[[x[xT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER ® .00 O U d OVERFLOW SEEPAGE PIT.DRAINFIELD 4=) EXTN..CESSPOOL.DRYWE LL. $5.00 U `/ f'/ry ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT CD MANHOLE $7.00 PERMIT NO. W INDUSTRIAL N WASTE APPROVAL Z OWNERS PERMIT S 00• CHARGES — AUTHORIZATION TOTAL FEE h 6 CONNECTION CHARGE FEE - I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT AL UILDING OR WORK B ADDRESS 3 / SEPTIC TANK,SEEP,PIT(S) i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR- LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFC,RN1A OR T 1 TME LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE BO E DES RIBEc RE51 IAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE d�]`�_`� BACKFILL SEPTIC TANKS ❑ OF PEQ MfT7EE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK. M.O. CASH _C)1A APENcZATION 4 4 1:O I'M Y 15 1 0 0 1 4.0 ASB POLICY NUMBC . /-5--33 = a-- 6A 5-65 7 642D APPLICATION FOR PER I 76A 64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING t JOHN A.LANIBIE, County Engineer ADDRESS COLEMAN R':JENKINS,Sup't. of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CRDSB ST. L ' LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS . NO. OF "LDS. SIZE OF LOT 4Q � NOW ON LOT / CITY TEL. NO. USE OF ` ® � fr DISTRICT NO. GROUP MAP P BUILDINGS RO ESSED BY �� BK PG ,�y CONTRACTOR ADDRESS C/O`NNECTION DATA l�, STATION DEPTH CITY "Ie TEL. NO. 3 LICENSE- LICENSE UPPER NO. CLASS MANHOLE REFERENCE NO. ' DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH ROM HOUSE SEWER CONNECTING TO `� �� Y. CURB P,L. M.L.TO .L. PUBLIC SEWER C-' $ 5.00 4 P.C. NO. d SEPTIC TANK, SEEPAGE PIT OR CO.IMP. NO. JOB NO. PI75 AND�OR GRAINFIELD C $10.00 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM C $ 3.00 CONNECT ADDITIONAL BLDG. OR AFFIDAVIT WAIVER EASEMENT RECORD. INSTR.NO. DATE Ix WORK TO HOUSE SEWER C $ 3.00 Q REAIR OR ABANDON HOUSE I— SEWER OR DISPOSAL SYSTEM C $ 3.00 bbd T, DHAINI­IhLU HWY. OR ST.WIDENING CL EXTN.,CES SPOOL, MANHOLE C $ 5.00 H STATE ENCROACHMENT PERCOLATION TEST C $ 5.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES AUTHORIZATION TOTAL FEE — y CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT-- - CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(5) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE' OF PERMITTEEBACKFILL SEPTIC TANKS ❑ SEEP,PIT(S) ❑ CESSPOOLS ❑ �- VALIDATIO K. -.- M.O. CASH ' - - LA["0.2 7.1 5:%a JAN 2.2 1 0 D 7.00-