HomeMy Public PortalAbout9208, 9210, 9212, 9212 1/2 LAS TUNAS DR_Sewer__ S& -669 1•55 D APPLICATION FOR PERMIT
S @ E-8 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
8 CASSATT D GRIFFIN, SUP T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
DESCRIPTION LOT NOt
MAIL 4-11
BLOCK TRACT / ADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OFDISTRICT NO GROUP MAP
BUILDINGS
PG
CONTRACTOR � /` ti � BK
CONNECTION DATA
ADDRESS
STATION i U DEPTH 17
CITY TEL NOC272 > MANHOLE REFERENCE UPPER
SSI ATE
REGISTRATION NO. ❑ COUNTY
No DESCRIPTION 0 WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM %
-7f Y. CURB P L M L TO PL
PUBLIC SEWER @ $3 50 G:
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT,DRAINFIELD �/ P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP. NO Jf JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK _
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN STATE OF ABANDON HOUSE SEWER
OR THAT AAI THE EGAL OWNE OF HE ABOVE
DESCRIBED CALIFORNIA,ESIDEN OPT BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) El CESSPOOLS
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A WOOD, Ctq]EF PLBG INSPECTOR
CK. !1 0k CAS
� 02 9 8-IS JUL 18 10 A 4,5 0 ;9