HomeMy Public PortalAbout9218-9224-9226 LAS TUNAS DR_Sewer__ 24650 INSE
760
76A642D APPLICATION FOR
PERMIT
842D 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL,-, 1
-DEPARTMENT OF,COUNTY ENGINEER .
BUILDING AND SAFETY DIVISION FADE
JOHN A. LAMBIE, County Engineer r
WILLIAM A. JENSEN, Supt of Building FOR APPLICANT TO FILL INNEAREST
.
LEGAL -r r fq
OWNER - .t
DESCRIPTION LOT NO. 6
BLOCK TRACT MAIL
49
J ADDRESS (if r G^�` �5/ k.?>✓t
NO OF S
SIZE OF LOT NOW ON LOTiCITY TEL NO
USE OF
BUILDINGS dISTRICT NO. GROUP BK G MAP PROCESSED BY
t� I � Q
CONTRACTOR t ,L ff
ADDRESS { CONNECTION DATA
CITY TEL N0. T ' /�Z� ,STATION�t_ DEPTH
UPPER
REGISTRA N NO �� ® STATE MANHOLE REFERENCE y 9, LOWER
COUNTY e�GaJ
NO I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 3 �—/�
PUBLIC SEWER @ $3 00 v TYPE OF CONNE N LENGTH FROM r
SEPTIC TANK SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. �.
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO / P C.NO.
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. NO / JOB NO. a
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO. ROAD PERMIT NO. U
WORK TO HOUSE SEWER @ $1 00
SEWER OR DA9POR OSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT pq
PERMIT NO
INDUSTRIAL
. WASTE APPROVAL W
CHARGES 2
OWNER'S PERMIT =$ 2 00 CONNECTION CHARGE FEE F1
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE ?�� G
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT TH BOVE DESCRIBED EXISTLNG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC_ EWER
SIGNED THIS AY OF� 196 f NEW HOUSE SEWER
OWNER OR I CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP PIT(S)
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 ALTER,SEWAGDISPOSAL EWERO SYSTEM
1 HEREBY CERTIFY THAT I AM P PERL RE ERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY S„AN ELES. OUN,T 'AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I THE T GAL OF.' OVE BACKFILL SEPTIC TANKS ❑
DESCRIBED ROR THAT PERTY. e
SEEP PIT(S) ❑ CESSPOOLS
SIGNATURE -
OF PERMITTE ^
®F V ATIONY---,, ROBERT A. WOOD
CK. M 0. ,(CASH ) SUPERVISING MECHANICAL, ENGINEER
451 MR, 28 1 c D 5 .00
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