HomeMy Public PortalAbout9901 LAS TUNAS DR_Sewer__ a
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ceeos-e-se APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES , SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGDMM
BUMDING AND SAFETY DMSION FADDRESS
G
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building Y
T
FOR APPLICANT TO FILL IN T.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
, ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY' TEL.N0.
USE OF
BUILDINGS DISTRICT N0. GROUP MAPOCESSED BY '
BK PG
CONTRACTOR' I
ADDRESS Zc-
CONNIEC DATA
CITY TEL.NO. _0 .2— 'STATION DEPTH
STATE MANHOLEREFERENCE UPPER
REGISTRATION NO. COUNTY LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONN TION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M L.TO P.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 `
HOUSE SEWER CONNECTING TONO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. R PERMIT N0.
WORK TO HOUSE SEWER Q $1.00
ALTER, R*P4W?.�G&.ABA*9eN HOUSE STATE ENCROAC NT
SEWER 0 @ $1.00• PERMIT NO.
INDUSTRjjAf
WASTEAPPROVAL '
CHARGES
OWNERS PERM $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS - DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC W�
SEg�.
SIGNED THIS AY OF !�' I g NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.-PIT(S)
ADDRESS' AND/OR DRAINFIELD _
i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 1S 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 I AM THE LEGAL-OWNER OF THE ABOVE
DESCRIBED,RESIDENTIA PER BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP.PIT(S CESSPOOLS❑
OF PERMITTE
VALIDATION ROBERT A.WOOD
E.p, cult 'suPERvISING MECHANICAL ENGINEER
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