Loading...
HomeMy Public PortalAbout9905 LAS TUNAS DR_Sewer__ 76A 642D—CE808—10-71 APPLI P CATION FOR ERM COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /� ADDRESS V ,57 rn LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL / DESCRIPTION LOT NO. OWNER (� MAIL BLOCK / ('T�RACIT�j�y `G ADDRESS � a �j � SIZE OF LOT �>�+ :3(/ NOWONLOTS CITY ..QijAt e[TV TEL. NO. a I USEOF OF d-YC4_ DISTRICT N0. GROUP BK MAP Z SSED BY p' r t 7�/ 6.0 NTRACTOR �� 4,57 /�.r l� �..R� ADDRESS iiill7 CONNECTION DATA STATION � DEPTH CITY TEL. NO. ,�- STATE LIC MANHOLE REFERENCEUPPER LICENSE NO: CLASS S v LOWE NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIONP.L. LENGTH FROM�S HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P.L. C PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC'TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 0- PRIVATE PRIVATE DISPOSAL SYSTEM @ S3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wntvEn EASEXENT RECORD. INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD O EXTN..CESSPOOL.DRYWELL. @ $5.00 HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE � SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT LLI MANHOLE @ $7.00 PERMIT NO. 0- INDUSTRIAL INDUSTRIAL N WASTE APPROVAL OWNERS PERMIT S 31 00 CHARGES AUTHORIZATION I TOTAL FEE © CONNECTION CHARGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLISEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONANSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TODISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENT L PROPERTY. ABANDON HOUSE SEWER SIGNATURE ❑ OF PERMITTEE ^f/1' BACKFILL SEPTIC TANKS SEEP.PIT( C SPOOLS ❑ ` VALIDATION CK M.O. CASH v 7 1 3 1 ­3 JUL 21 1 0 D 6.0 0-