HomeMy Public PortalAbout9822 LAS TUNAS DR_Sewer__ C89C628.09 APPLI& ATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
ADDRESS .4�0
MUZ
JOHN A. LAMBIE, Count Ea eer
CASSATT D. GRIFFIN, Sup t of$adding LOCALITY
NEAREST
FOR APPLICANT TO FILL TM
CROSS ST.
LEGAL �/
DESCRIPTION LOT NO. 'T OWNER ' g
BLOCK TRACT' MAIL
lS ADDRESS
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROUP K MAP PG CESSED BY
CONTRACTOR j orf G-'d
r �p �1
ADDRESS cJ (J Q COLLL•.NNECTIO(/N DLA_TA
CITY TEL.N0. ��� STATION 1 DEPTH
ATE MANHOLE REFERENCE '
_REGISTRATION NO. � �/ COUNTY LOWER
'NO. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OFC ECTION LENGTH FROM G� /
SEPTIC TANK,SEEPAGE PIT OR Y. U7 P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
PRIVATE DISPOSAL SYSTEM E SEWER CONNECTING TO @ $1 00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $100 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - STATE ENCROACHMENT
SEWER OR'DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES_
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE C� REIMBURSEMENT FEE ��pq
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED
CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
t 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. SEWAGE DISPOSAL SYSTEM
I 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 t AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN L PRO RTY. BACKFILL SEPTIC TANKS ❑ D/ G
SIGNATURE SEEP.PIT(S) CESSPOOLS
OF PERMITTE
®� VALIDATION ROBERT A. WOOD
CK. m,p_ \ CA59 SUPERVISING MECHANICAL ENGINEER
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