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HomeMy Public PortalAbout9914 LAS TUNAS DR_Sewer__ 0-63 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO /O OWNER MAIL BLOCK TRACT �JJ ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PRO SSED BY BK PG CONTRACTOR r ADDRESS a _ CJ CONNECTION DATA 5T ION DEPTH CITYa-1416 I TEL NO p�� / N-- LERE STATE MANHOE NCE UPPER REGISTRATION NO S_62-dg' K .jp ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CON TION LENGTH FR HOUSE SEWER CONNECTING TO Y CURB P L ML TOP } PUBLIC SEWER @ $5 0o d SEPTIC TANK,SEEPAGE PIT OR P C NO O PITS AND/OR DRAINFIELD @ S1000 CO IMP NO JOB N V HOU 5E SEWER CONNECTING TO TRUNK PERMIT NO 7X-1_R MIT NO PRIVATE DISPOSAL SYSTEM @ S3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT ORD INSTR DATE WORK'TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL,DRYWELL,MANHOLE @ $500 ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENIN H SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACH NT PERMIT NO INDUSTRIAL WASTE AP OVAL OWNERS PERMIT S a 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 4 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWE _ APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGEN CONNECT ADDITIONAL ✓ ADDRESS BUILDING OR WORK SEPTIC TANK SEEP,PIT IS) I HEREB A NOW LEDGE TH 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE AT THE ABC _S CORRECT AND AGREE TO COMPLY WITH ALL OUNTY ORDIN CES Al. STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL 1 HEREBY CERTIFY T 1 M PROPER REGISTERED AND/OR ALTER,REPAIR SEWER OR LICENSED AS REQUIRE H BY LOS ANGLE . UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THA AM THE LEGAL WNER F, Y4D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A VE ESCRISED SIDENT P OPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS E]OF PERMITT SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION---,-) ROBERT A. WOOD CK M 0 CASHSLYPERVISING MECHANICAL ENGINEER LA 2 4 6 0` x'20 1 0 a 6.00 7 "0" 10-63 APPLICATION FOR PERMIT A642D v COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL I DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FjL..AL,11 ILDING JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building NEAREST __.-. _ -.. -_.__-___.- FOR APPLICANT TO FILL IN CROSS .T- - _ - LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS - NO. OF BLDG S. IZE OF LOT NOW ON LOT CITY - TEL. NO. '.E OF DISTRICT NO. GROUP MAP PROCESSED BY 'JILDINGS BK PG TRACTOR ESS CONNECTION DATA STATION DEPTH TEL. NO. r ❑ STATE MANHOLE REFERENCE UPPER ATION NO. ❑ COUNTY LOWER d DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM O SE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. V LIC SEWER @ $5.00 IC TANK,SEEPAGE PIT OR P.C.NO. LLI AND/OR DRAINFIELD @ $10.00 CO. IMP. NO. JOB NO. SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U_ E DISPOSAL SYSTEM @ $3.00 } T ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD, INSTR,NO, DATE HOUSE SEWER @ $3.00 Q W SEEPAGE PIT,DRAINFIELD SPOOL.DRYWELL,MANHOLE @ $5.00 O AIR OR ABANDON HOUSE HWY.OR ST.WIDENING d ISPO.AL SYSTEM @ $3.00 STATE ENCROACHMENT W PERMIT NO. F INDUSTRIAL WASTE APPROVAL CHARGES PERMIT $ 00 CONNECTION CHARGE FEE ON I TOTAL FEE TE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE CT THE ABOVE DESCRIBED EXISTING DWELLING ER. APPROVALS DATE INSPECTOR'S SIGNATURE DAY OF 19_ NEW HOUSE SEWER CONNECT ADDITIONAL BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) Ew..-THAT IHAVE READ THIS APPLICATION AND/OR DRAINFIELD ABOVE.IS CORRECT AND AGREE TO COMPLY DINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL ❑ IATI AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM M THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND SCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS ❑ -- '-- - SEEP.PIT(.) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK, A O. CASH f 64 2D 5-65 76AAPPLICATION FOR PERMIT 76A 64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAURIE, County Engineer ADDRESS J COLEMAN W JENLINS, Supt of Building LOCAL,TY NEAREST FOR APPLICANT TO FILL IN S. ST DESLEGAL CRIIPTION LOT NO /O OWNE. UDeMAIL BLOCK TRACT �0 ADDRESS 9 1 / � f... ✓�(J NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCES D BY CONTRACTO K^. PO ' / ADDRESS Z �f CONNECTION DATA r STATIN Lyq / DEPTH CITY TEL NO 3 Z "�a O O UPPER No CA NSE/ / CLA SSSE _3 `P MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L PUBLIC SEWER $ 5 00 SEPTICNTI , SEEPAGEPIT OR P C NO d PITS AND/OR DRAINFIELD C $10 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM C $ 3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER C $ 3 00 H HOUSE SEWER ORC==ef=tL SYSTFMC $ 3 00 O W HWY OR ST WIDENING d N EXTN ,CESSPOOL, MANHOLE CI $ 5 00 STATE ENCROACHMENT Z PERCOLATION TEST C $ 5 00 PERMIT NO INDUSTRIAL , WASTE APPROVAL CHARGES RAS PERMIT $ 2 00 AUTHORIZATION 1 TOTAL FEE o O CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR 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 TANKSEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAI NFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL F-1DRYW ELL El I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR -�- LICENSED AS REQUIRED BY LOS ANGLES COUN AND STATE OF SEWAGE DISPOSAL SYSTEM ��` CALIFORNIA OR THAT IA THE LEGAL OWNER AND INTEND TO ` J DISCONNECT PLUG AND RESIDE IN THE AS E SCRIBED RESIDENTIA PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PE SEEP PIT(S) ❑ CESSPOOLS ❑ VCKALIDATION M O CASH E ACO 3 5 9 5' jUL 19 1 o D 5,00- 17 76A642D APPLICATION FOR PERMI 6A64IJ COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSA DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIN JOHN A" LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CRD59 ST LEGAL O DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT SJ�j ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP );O�C:�ESBY BUILDINGS BK PG CO-TRACT-R, AD ES CONNECTION DATA CI Y • TEL NO �lp STATION DEPTH 0 ATE REGISTRATION NO ©/ COUNTY MANHOLE REFERENCE WER NO DESCRIP ION OF WORK FEE TYPE OF CONNECTION LENGTH FR/ HOUSE SEWER CONNECTING TO Y CURB P L M L TOP PUBLIC SEWER @ $S 00 vc. PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO 9" PITS AND/OR DRAINFIELD @ $10 000 j O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO!(7j/ V PRIVATE DISPOSAL SYSTEM @ $300 , CONNECT ADDITIONAL BLDG ORQ� AFFIDAVIT WAIV[[ [A5[M[NT RECORD INSTR NO DATE 0 WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD E%TN,CESSPOOL,DRYWELL,MANHOLE @ $5 00 (yf ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT U) PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT !"s6�2 00± OO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HER IN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT E ABOVE DESC El TING DWELLIN APPROVALS TO THE PUBLIC SEW DATE INSPECTOR'S SIGNATURE SIGNED THISDAY 1SZz OWNER OR NEW HOUSE SEWER OWNERS AGENT ' CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP,PITS) I 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 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT THE LE AL OWNER OF, AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO DESCRIB RES E TIAL PR RTY ABANDON HOUSE SEWER SIGNATURE -49 OF PERMITTEE BACKFILL SEPTIC TANKS ❑ ��� SEEP,PIT(S) ElCESSPOOLS VALIDATION ROBERT WOO CK M o /�.C�SHSUPERVISING MECHANICAL ENNICAL ENGINEER jC0 9 4 4 5- FEB 7 1 0 D 1 3.0 0- IN