HomeMy Public PortalAbout9214-9216 LAS TUNAS DR_Sewer__ TEMPLE CITE'
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CE808 8-89 APPLICATION FOR PERMIT
E806
COUNTY OF LOS ANGELESSEWER-SEWAGE DISPOSAL ___
DEPARTMENT OF COUNTY ENGINEER
ER
AND SAFETY DIVISION BUILDING„
ADDRESS I (t
JOHN A. LAMBIE, County Engineer N
CASSATT D. GRIFFIN, Supt of Building LOCALITY P ,
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.CCL---VL > �.
LEGAL 0O
DESCRIPTION LOT N0. f OWNER f '
BLOCK TRACT MAIL 17
ADDRESS
X-- NO OF BLDGS.
SIZE OF LOr� Q NOW ON LOT CITY - TEL NO
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PR ESSED'BY
(J BK PG
CONTRACTOR �: � � f� r r�
ADDRESS CONNECTION DATA '
CITY TEL N ^ STATION DEPTH
TE MANHOLE REFERENCE �' UPPER
REGISTRATION NO. PCUNTY ' LOWER
NO. DESCRIPTIO 0 WORK FEE
HOUSE SEWER CONNECTING TO Irl
PUBLIC SEWER @ $3.00 u TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD th-
EXTN. CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TOP C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. / JOB NO.
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1 00
A'TER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS BDATE INSPECTOR'S,-SIGNATURE'
TO THE PUBLIC SEWER. (`-
SIGNED THISDAY OF 19_ NEW HOUSE SEWER
OWNER OR
OWNERS AGENT CONNECT ADDITIONAL I F '
ABUILDING OR WORK
ADDRESS SEPTIC TANK,AND/OR DRAINFIELD
PIT(S)
ELDC
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION t
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
1 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 T GAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROP Y. BACKFILL SEPTIC TS ❑
SIGNATURE SEEP.PITS ❑_CSI
CESSANKPOOLS
OF PERMITTE
)r VALIDATION ROBERT A.'WOOD
M.o. CASH SUPERVISING MECHANICAL ENGINEER
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