HomeMy Public PortalAbout9730, 9730 1/2 LAS TUNAS DR_Sewer__ 2465® ANTS
78A
64
2 6 ID60 APPLICATION ION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDR-ESS
IOlirt A. LAMIE, County Engineer
1NFLLIAM A; JENSEN,Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN
LEGAL - –�-
DESCRIPTION LOT NO, - OWNER..
BLOCK TRACT MAIL
ADDRESS
_
SIZE OF LOT_ _.2 f< r NOW ON LOT NO,OF BLDGS. i� CITY TEL. N0.
OF
BU
E DINGS_C - -.L..,� ,�_ DISTRICT NO. GROUPBKC PG MAP P CESSED.BY
f
[0. 1
TOR �;IJC ? ! r..
CONNECTION DATA
TEL.NO. STATION ; v , DEPTH ,
❑ STATE MANHOLE REFERENCE / UPPER?
ATION NO. ❑ COUNTY /C
DESCRIPTION OF WORK FEE
USE SL,4 CONNECTING TOBLIC SEWER C- $3.00 S k TYPE OF CONNECT LENGTH FROM
PTIC TANK. SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.TSAND,'ORDRAINFIELD @ $3.00ERFLOW SEEPAGE PIT, DAINFIELD
TN.. C59SPOOL. DRYWELL @ $2.00USE'SEWER CONNECTING TO # P.C.NO.
tYATE DISPOSAL SYSTEM @ $1.00 CO. [MP. N0. y' 3 .� . JOB NO.
NNECT itl>Dl'CtONAL ELDG.OR TRUNK PERM]T N0. ROAD PERMl'T N0, O
94
RK TO HOUSE SEWER @ 51.00 U
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT 04
. .SEWER OR piSPOSAL SYSTEM @ $1..00 PERMIT NO, O
INDUSTRIAL '
WASTEAPPROVAL W
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE f, + :' r:' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOA'SSIGNATURE
1.0 THE PUBLIC SEWER, –
SIGNED THIS , —DAY OF_..__._.. 18
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT—,— "" BUILDING OR WORK
ADDRES ' _ _ SEPTIC TANK.,SEEP.PIT(S)
S.
—S_— ---- _ AND/0R DRAINFIELD
I 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
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND S'CATE OF ABANDON DISHOUCONNECT
D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.. BAC.KFILL$EPTICTANKS ❑
SIGNATURE
SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTEE -
'r — VALIDATION ROBERT A. WOOD
C& / M.0. CASH SUPERVISING MECHANICAL ENGINEER