HomeMy Public PortalAbout9831 LAS TUNAS DR_Sewer__ - � r
76A64 3-64 APPLICATION FOR PERM
76A642D u
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING J /
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building /
LOCALITY �ix C -
NEAREST
FOR APPLICANT TO FILL IN C... 6T
LEGAL
DESCRIPTION LOT NO OWNER C 0
�1 �6/ MAIL
BLOCK TRACT (Q ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT ' CITY TEL NO
USE OF DISTRICT NO GMAP PROCE D BY
ROUP
BUILDINGS %Vl M BK
''7
CONTRACTOR �, V 1 . 1P-2 V
ADDRESS p e k
,y CONNECTION DATA
CITY �(, ,v TEL NO t Ive/C STATION DEPTH /^
REGISTRATION NO <� 7 / LI COUNTY MANHOLE REFERENCE ,JJJ ER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGT PROM
HOUSE SEWER CONNECTING TO Y CURB P L M L P.L
PUBLIC SEWER SS 00
SEPTIC TANK,SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD S1000 CO IMP NO .108 NO 0_
O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PER (i
PRIVATE DISPOSAL SY STEM 3300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIV[11 [ASIMIINT RECORD INSTR NODATE O
WORK TO HOUSE SEWER $300
OVERFLOW SEEPAGE PIT,DRAINFIELD f'
EXTN,CESSPOOL,DRYWELL,MANHOLE @ SS 00 ALTER REPAIR OR ABANDON HOUSE HWY OR 8T WIDENING UJ
O_
SEWER OR DISPOSAL SYSTEM $300 STATE ENC CHMENT N
PERMIT NO Z
INDUSTRIAL
WASTE APPROVAL
CHARGES
O RAS PERMIT $1 2 00
AUTHORIZATION TOTAL FEE ®?A CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR
REIMBURSEMENT FEE
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT \�"� CONNECT ADDITIONAL
BUILDING OR WORK ,�-
ADDRESS SEPTIC TANK,SEEP,PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I M PROPERLY GISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY S ANGLES OU TY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM E LEGAL O NER OF AND INTEND TOf
ISCONNECT PLUG AND
RESIDE IN, THE ABOVE 5 RI ED RESI EN L ROPE TY BANDON HOUSE SEWER
SIGNATURE ACKFILLSEPTIC TANKSOF PERMITTEEEEP PIT(S) ❑ CESSPOOLS
/ VALIDATION ROBERT WOOD
CK M 0 CASH SUPERVISING MECHANICAL ENGINEER
LJ1Co 1 4 7 31 MAY 11 1 0 D 5.0 0 "