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-