HomeMy Public PortalAbout9149 LAS TUNAS DR_Sewer__ • ,.."• 50 INSECS
CE8086.80 �gppLlC�4 IOM FOR PERMIT
76A642D COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL 1.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINESSG t^�
ADDR
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt of Building LOCALITYNEAREST A
Cie
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT �O j-'� MAIL
J ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE
BUILDINGS BK DISTRICT NO. GROUP MAP PROjrESSED BY
-
CONTRACTOR v -
ADDRESS t �C 118— ,j-S' 77 CONNEC DATA -
CITY TEL.NO./-,,o 4P14/l❑ O STATION DEPTH
STATE REGISTRATION NO. J O ❑ COUNTY MANHOLE REFERENCE - of ...may UPPER
NO. I DESCRIPTION OF WORK FEE L. ✓
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB' P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL Co) $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
CO.IMP. NO. JOB NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 >.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ $1.00
SEWER OR DISPOSAL SYSTEM HOUSE @ $100 STATE ENCROACHMENT04
-PERMIT N0, O
INDUSTRIAL U
WASTE APPROVAL W
CHARGES ca
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGDATE A CONTRACT WITH THE HEREINAMED DWELLIING APPROVALS DAYE INSPEC R'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL --
OWNERS AGENT BU OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS. APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TH T AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDE 1 PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTEE
®F VALIDATION ROBERT A. WOOD
CK. M.0, CAs6 SUPERVISING MECHANICAL ENGINEER
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