HomeMy Public PortalAbout9154, 9154 1/2, 9158 LAS TUNAS DR_Sewer__ S&&E663 11-SS° APPLICATION AOR PERMIT- . .
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DIVISION OF BUILDING AND SAFETY SEWER SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING Q� riIri �
JOHN A. LAMBIE, COUNTY ENGINEER —ADDRESS Las Timam
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® - CASSATT D. GRIFFIN, SUP'T QF BUILDING LOCALITY Temple City -
NEAREST
FOR APPLICANT TO FILL IN -CROSS ST.gip@
LEGAL OWNER E. Phillip Schmidt
DESCRIPTION LOT NO. h�� � LL .
MAIL
BLOCK TRACT 905 ADDRESS 'p 0-T RnX I I
N0.OF BLDGS.
SIRE OF LOTNOW ON LOT CITCorona_ D
, el. MaUL. NO...
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USE OF DISTRICT NO. GROUP MAP
BUILDINGS � C BK PG
CONTRACTOR _ /-�'
fi uzare Deal Seswer Servs c� V 7
CONNECTION DATA
ADDRESS 2933 Mal—son Rd. /.
STATION _It i _5DEPTH G:
CITY ITEL. NO.
G! 24MANHOLE REFERENCE •• j - _
1 ' STATE - LOWER
REGISTRATION NOC..-[L2 �? ''JC [ICOUNTY NO. DESCRIPTION OF WORK ' FEE
HOUSE SEWER CONNECTING TO Y-
TYPE OF CONNECTIO LENGTH FROM t.
PUBLIC SEWER @ $3.50 . CURB P.L. M.L.TO.P.L.
SEPTIC TANK,SEEPAGE PIT OR ,
PITS AND/OR DRAINF.IELD. @ $-3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0. -
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 _CO. IMP. NO. ,/ /' 7 JOB N0,
HOUSE.SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO-HOUSE SEWER @ $1.00 PERMIT NO. '
ALTER,REPAIR ORABANDON HOUSE INDUSTRIAL _
- SEWER-OR DISPOSAL SYSTEM - @ $1.00 WASTE APPROVALar _
CHARGES
CONNECTION CHARGE FEE - -
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE U REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS' DATE INSPECTOfJ,�S SIGN ATURE'
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,TO THE THE PUBLIC SEWER.. - NEW HOUSE SEWER
SIGNED THIS DAY OF 79 CONNECT ADDITIONAL
OWNER. OR. BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)ommerica
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL El 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
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
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El -
t SEEP..PIP(S) ❑ CESSPOOLS -
SIGNATURE -
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD.CHIEF PLBG. INSPECTOR
._ ... CK.' M. 0. CASH
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