HomeMy Public PortalAbout9201 LAS TUNAS DR_Sewer__ (
TEMPLE CITY
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: . _ APPLI'CA,TION FOR PERMIT :._..--,..
E808 B-58
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY'DIVISION BUILDING
ADDRESS
JOHN A. LAIE, County En ineex
MB
CASSA'1TP D.'GRIFFIN, Supt o4 Building LOCALITY �l T
NEA �
LEGAL FOR APPLICANT TO''FILL IN 77 M;REST ST.
DESCRIPTION LOT NO. �6+ �0. OF" ♦ OWNER
BLOCK TRACT MAIL /
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT OA 4:!b CITY TEL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP P ESSED BY
BK PG
CONTRACTOR 1
ADDRESS Z4 7 /H -n a AS CONNECTION DATA
CITY ` r TEL.NO. I r2d 4 STATION i, DEPTH }
STATE MANHOLE REFERENCE _ UPPER
REGISTRATION NO. ® COUNTY t' !
No. DESCRIPTION OF WORK FEE
HOUSE`SEWER�.CONNECTING TO
PUBLIC SEWER' @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CU B L. M.L.TO P.L.
'7
PITSAND/OR DRAINFIELD @ $3.00
OVERFLOW'SEEPAGE PIT,DRAI NFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO / P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK T0.HOUSE SEWER' @ $1.00 `1
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
' CHARGES'
OWNERS PERMIT $ 1 2100 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEES REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR.TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DAT - INSPECTOR%3 SIGNATURE
S THE PUBLIC SEW€R. �' +
ED'THIS DAY 0 19_ NEW HOUSE SEWER
SIGN
OWNERORCONNECT ADDITIONAL
OWNERS.AGENT �•�°"4 BUILDING OR WORK
/- -f
. Aj `4� SEPTIC TANK,SEEP.PIT(S)
DDRESS J G
AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT I 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
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 M THE LEG L OWNER OF THE ABOVE
DESCRIBED RESIDENTIA- R ERTY. BACKFILL SEPTIC TANKS El
SIGNATURE SEEP.PIT(S ❑ CESSPOOLS
OF PERMITTE
VALIDATIOROBERT A. WOOD
CIL M.0. CAsN SUPERVISING MECHANICAL ENGINEER
LhUo s o b 4 10
r LAR 2 � 0n 3.0 0
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