HomeMy Public PortalAbout9163, 9163 1/2 LAS TUNAS DR_Sewer__ r
DEBOB 5-65
76A 642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A LAMBIE, County Engineer ADDRESS �A
COLEMAN W JENKINS,Sup't of Building j
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
MAIL /
BLOCK TRACT D(5— ADDRNO ESS 6/ ��LP�f{•jrt•�� {�' j�(r.��•,/ f�
SIZE OF LOT NOW OON LOT /CI CITY TEL NOr) y/- .2
l / DISTRICT NO GROUP MAP PROCESS BY
BU
USE
PG
CO NTRACTO ( f �� O Z�
AD(D SS sL ' Gcr�{�� CONNECTION DATA
CIT y�.• TEL O STATION DEPTH
N /
CENS
LIC
LICENSE
/ 7/CLASS
N2, MANHOLE REFERENC LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTIOLENGTH OM
HOUSE SEWER CONNECTING TO Y CURB _PL
L M L TO L
PUBLIC SEWER C $ 5 00
PT IZ D @ANC-(, SEEPAGE PIT OR PC NO CO IMP NO JOB NO O
PITS AND/OR DRAINFIELD $10 00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM @ $ 3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE Om
WORK TO HOUSE SEWER C $ 3 00 W
'ALTER, REPAIR OR ABANDON H008E
SEWER OR DISPOSAL SYSTFM C 'tUVEHI-U 01 AINFIELU 3 00
HWY QRST WIDENING
Uw
EXTN ,CESSPOOL, MANHOLE C $ 5 00 STATE ENCROACHMENT Z
PERCOLATION TEST C $ 5 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S z o0
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THF HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT E ABOVE DESC B_EO EXISTING DWELLIN
TO THE PUBLIC SE EI� APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS OF
OWNER OR /, / NEW HOUSE SEWER
NT
OWNERS AGE ��/� G 1
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK SEEP PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 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 ❑
IHEREBY CERTIFY THaX I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRE-D Y LOS ANGLES COUNT AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I M T LEGAL OWNER AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE AB DES IBED R SIDEyI ROPERTY ABANDON HOUSE SEWER
SIGNATURE f ❑
OF PERMITTE BACKFILL SEPTIC TANKS
SEEP PITS) ❑ CESSPOOLS
VALIDATIO -
CK M O CASH
Lcl�� 4 2o AUG 17 1 o Q 7.001-
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