HomeMy Public PortalAbout9953 LAS TUNAS DR_Sewer__ ,D_82
76AG42D APPLICATION FOR PERM
78A 64
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS V�
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FII.L IN `Ross ST
LEGAL
DESCRIPTION LOT NO OWNE
MAIL
BLOCK TRACT s ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO �-
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESS ?Y
;G7
BK
CONTRACTOR
ADDRESS :,e,,,< ONNECTION DATA
STATION DEPTH /
' EL NO
TATE MANHO REFE CE _
REGISTRATION NO COUNTY / a
NO I DESCRIPTION OF WORK FEE TYP OFC NNECTION LENGTH F M
HOUSE SEWER CONNECTING TO � Y CURB PL M L TO O O
PUBLIC SEWER @ $5 00 .
SEPTIC TANK,SEEPAGE PIT OR P C NO
CO IMP NO JOB NO O
PITS AND/OR DRAINFIELD @ $1000 r`yY,
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N W
PRIVATE DISPOSAL SYSTEM @ $300 uuuJJJJ
CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVEE I EASEMENT RECORD INSTR NO DATE d
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN,CESSPOOL,DRYWELL,MANHOLE @ $500 HWY OR ST WIDENING
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERM $ z 00 CHARGES
AUTHORIZATION TOTAL FEE 67
CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRY (ISTING DWELLING
TO THE PUBLIC SE APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19 1 -
OWNER OR /' ( NEW HOUSE SEWER
OWNERS AGENT f
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK !
ASEPTIC TANKSEEP,PIT(S)
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 ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT M TH LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB DESC BE EN IA ROPERTY
�
OF PERMITTEE g ABANDON HOUSE SEWER
SIGNATURE ` BACKFILL SEPTIC TANKS ❑
❑
SEEP PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
CK M O CASH
SUPERVISING MECHANICAL ENGINEER
WCOJ 78 7%-D'- FEB 21 1 :) D 7,U0
76A6420 +
LE 806 REV 6/781
®S APPLICATION 'FOR PERMIT
r , 4
' SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING-AND SAFETY'
DI
FOR APPLICANT TO FILL IN, STRICT No GROUP MAP PDBY
BK ^SPG P
ABUILDING DDRESS �i� a S Y7 •�j` LsJ ROCESSE✓ UV
LOCALITY CONNECTION DATA
C,
NEAREST STATION I nLia36
DEPTH
CROSS ST
MANHOLEREFERENCE LOWER
OWNER TYPE OF CONNECTION LENGTH FROM
MAIL _ Y CURB L M L TO P L J
ADDRESS
� PC NO '
+cT��7� j ^� CO IMP NO e� JOB NO.
CITY TEL NO '
J
LEGAL TRUNK PERMIT NO ROAD PERMIT NO
DESCRIPTION LOTNO +,
i
AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE .
BLOCK TRACT
NO OF BLDGS
SIZE OF LOT NOW ON LOT HWY OR ST WIDENING ,
USE OF
BUILDINGS - STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
CONTRACTOR WASTEAPPROVAL
ADDRESS 221
CHARGES
CONNECTION CHARGE FEE
CITY TEL NO
STATELIC REIMBURSEMENT FEE
LICENSE NO / CLASS
NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR S SIGNATURE (�
HOUSE SEWER CONNECTING TO 0S
PUBLIC SEWER
NEW HOUSE SEWER
SEPTIC TANK,SEEPAGE PIT OR
.� PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO 'BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
STANK SEEP,PIT(S)
CONNECT ADDITIONAL BLDG OR AND/OR
DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,DRAINFIELD_ CESSPOOL ❑ DRYWELL❑
EXTN,CESSPOOL DRYWELL MANHOLE
ALTER REPAIR OR ABANDON HOUSE , ALTER REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE'DISPOSAL SYSTEM
'• - DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS[] ��-L•L �,
OWNER'S '
Permit s -7 SEEP,PIT(S)ED CESSPOOLS❑ U Q A
AUTHORIZATION FTOTAL FEE VALIDATION o 0'10 'o 0
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 2 O O 1 Q O O
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,
TO THE PUBLIC SEWER
SIGNEDTHIS 4_DAY OF + Ig/, ,o`o-o 1-�,O Q -
OWNER OR - Q�-+G. o �/
OWNERS AGENT
ADDRESS
I'HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION •
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING _
PLUMBING AND SEWERS
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR e r
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AMTHE LEGAL OWNER OF AND INTEND TO RE-
SIDE IN THE ABOVE DESC/R IBED RESIDENTIAL PROPERTY +
SIGNATURE ( -
OF PERMrTTEE