HomeMy Public PortalAbout9810 LAS TUNAS DR_Sewer__ j
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C. APPLICATION FOR PERMIT),
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BU IL.DING
JOHN A. LAMBIE, County Engineer ADDRESS �
WILLIAM A. JENSEN, Sup`, of Building
LOCALITYY'
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NEAREST r-- — ,-✓�'— .—� �.�
FOCRO-15 R APPLICANT TO FILL IN - --_
DESCRIPTION OT NO ... OWNER
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7- _ MAIL.
BLOCK TRACT �...-_.~ DDREG5
NO. OF
E OF LOT NOW ON LOT CITY
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-- -- _— —� _- -- DfSTRIGT Np. GROUP MAP PRGCES
U+E OF .. _
B tJILD NG d r"�, �y't BK PG BY
CONTRACTOR_
ADDRESS j _/— CONNECTION DATA
CITY) 3 r j ( +i �/ EiN STATION/� ., / / DEPTH
--� J )? i:"C TEL NO. � --��<3-�. d. _�._.-_ ..w_ ✓- -_ __ -.
STATE. UPPER_ef
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REGISTRATION N11, f MANHOLE REFERENCE
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A-::.:� j'�..COUNTY � @,
NO. DESCRIPTION OF WOR.IC FEE TYPE OF CONNECTION- LENGTH FROM
`., HOUSE SEWER CONNECTING TO ---- Y. CURB P.L. M.L.TO P.L, - C1
yam. PUBLIC SEWER '. ':
SLP7l CYP NK SEE:PAGt-F(T r.,�.g3.�__$5-00 L ..;,r-i'g c._-' .- _-- P C NO
�T . Y -
(TS ANO CR DRAINF( 16 L $10.00 CO. IMPNO
—{- -.. OB NO.
-- 140115E SEWER CONNECTING TO TRUNK
PERMIT NO. - -- rtC.AD PERMIT NO.
--�--- v
PRIVATE J S OSAL SYSTEM @ $3.00 Ali
L
`d
CONN ECT _-
. L NO.-�` DATE AFFIDAVITEe -
WORK TO HOSE SEWER a-z
OVERFLOW SEPA,E
3°17.DRAfNFIELD
EXTh'.,CESSPOOL.DRY WELL,MANH OLE r $5 00
- ___— HWY.OR ST.WIDENING
AL7EF2,REPAIR OR ABANDON HOUSE
I S.WER OR DISPOSAL SYSTEM � $3.00
___ __ -.._ -_ ___—_. _ STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
p�[gy�7�a , j WASTE_APPROVAL
9tY Ati A. PERMIT _ ..- ---_ CHARGES
0.d
2 00 .
----�---�-- - ---- - --_-- -- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE � ----- ---- ---- ---- -------------"
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RE;MBURSEMEN7 FEE
---
__ -._ _.
TRA TO CONNECT THE ABOVE DESCRIBED FX:S""TING DW F;.LLING —. 9� ----_____—
TO THE PUBLIC S-W '-3-.'- ��}� ., APPROVALS DATE iINSPECTOR'S SIGNATURE
-_
SIGNED THIS - DAY U'F s��''�'r''�e:' .ad
OWNER OR w� NEW HOUSE SEWER
OWNERS AGENT - Ht;✓�' _ �-.�
X
CONNECT ADDITIONAL
BUIa_DING OR WORK I ..
--'-- - - - -� SEPTIC TANK SF PIT(S) 7---_
IHEEREBY ACKNOWOEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD J
AND STATE THAT THE ABOVE 75 CORRECT AND AGREE TO COMPLY - -____
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
P LU MB:IN- AND SEW E%2S. CESSPOOL Ej DRYWELL Ej
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR �
L10EN hD AS REQUIRED BY LOS ANGj ;S S:O.U.D['LX AND STATE OF SEWAGE DISPOSAL SYSTEM
ALIFORNiA OR T+;1T-4 AWH- LEGAL O TIER OF AND I £N O I 'OHNE
R,:'sIDE IN .. T-r Km- ABOVE OFSCRfi9 RF5 h_7 RU Ep�'V. D S� CT L.UG AND
ABANDON HQU.E SEWER i
SIGNATURE_ ; f -.
OF PERMIT'TEE �
c, gyp „.qsq ", _ .r" .�„s"` BACKFILL SEPTIC TANKS F
SEEP,PIT L] CESSPOpLS
VALIDATION ROBERT A. WOOD
CK. M.O. CASHSUPE.RV(SiNG NIECHANICAL ENGINEER