HomeMy Public PortalAbout9171 LAS TUNAS DR_Sewer__ 76A6420
E-669 11-88 E-88
'S& APPLICATION_ FOR P;ERi1ll_IT _ i
- '
DIVISION OF BUILDING AND SAFETY S EWE R-SEWAGE D,I S 0SA,L
Department-of County Engineer
County of Los, Angeles BUILDING
JOHN A. LAMBI'E: COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN,�SUP'T OF ElWLDING ,LOCALtITY -
"NEAREST• "
FOR'APPLICANT`TO FILL IN wCROSS ST.
LEGAL / OWNER _
DESCRIPTION LOT NO (� je
BLOCK - TRACT (MAIL` v!
/ J ADDRESS _
!llNO. OF BLDGS. CITY �^ TEL. N0.
SIZE OF LOT NOW ON LOT
USE
-BUILDINGS DISTRICT NO. GROUP MAP
43 BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
1
STATION DEPTH
CITY TEL. NO. MANHOLE-REFERENCE PPER'
ATE ,?// / /P i
REGISTRATION NO. a {] COUNTY,
I VOW—
NO DESCRIPTION OF WORK FEE
01
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION "" LENGTH FROM
PUBLIC SEWER @ $3 50 Y. CURB L" _ M L.TO P.L-
for
SEPTIC TANK,SEEPAGE PIT OR
I _ PITS AND/OR DRAINFIELD - Q $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP NO. - JOB NO.-
HOUSE
O.HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT N0. ROAD PERMI 0
CONNECT ADDITIONAL BLDG OR ;STATEICNQOACHMENT
WORK TO HOUSE SEWER Q $1 00 PERM IT.NO.
ALTER,REPAIR OR ABANDON HOUSE - ,;,INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM Q $'I'00 WASTE APPROVAL '
ya CHARGES
�I
rCO�NNECTI N CHARGE FEE '
OWNERS PERMIT $ 1 00 •
- REIMBURSEMENT FEE -
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- " APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS—� DAY OF 19s� CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN, A _ SEPTIC TANK,SEEP, PIT(S)
ADDRESS - AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE CA
THAT 1 HAVE READ T APPLITI CESSPOOL❑ 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED LOS ANGELES C UNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT M TYEGY(,6NER OF THE AB VE -DESCRIBED RESIDENT A P OPER ^ BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS,[:]SIGNATURE ,
OF PERMITTEE
JOHN A LAM E, COUNTY E G _ EER ALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK Y 0 CASH