HomeMy Public PortalAbout9413, 9413 1/2, 9415, 9417 LAS TUNAS DR_Sewer__ 76A 6:2D�-CE606-10-71 .APPLICATION F ERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FU
DING
ESS Tunas Drive
LITY Temple City
EST
FOR APPLICANT TO FILL IN S 5T, D
LEGAL RAF', Doo if son
DESCRIPTION LOT NO. C OWNER
n MAIL
BLOCK TRACT /l[^/ ADDRESS 94/117 LAs� Tunas Drive
SIZE OF LOT '` d `'' NOWOON LOTS CITY Temple City TEL. NO. 287-0766
USE OF DISTRICT NO. GROUP MAP ;'ElSEO BY
BUILDINGS '
/'�� D BK p,
CONTRACTOR �:/M1en pBros. Plumbing ��' �'Lj F Z
ADDRESS 4265 N. Baldwin Ave. CONNECTION DATA `
CITY El Monte TEL. NO. "3-.0078 STATION „� DEPTH
'
SIC ENSE NO,. 231 741 OLA SS C36-2o TATE LIC MANHOLE REFERENCE � / ? LPA
NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION /YJA ENGTH FROM
OUSE SEWER CONNECTING TO Y. CURB P.L. MI.L.TO P.L.
PUBLIC SEWER @ $7.00
P.G.NO.
SEPTIC TANK.SEEPAGE PIT OR JOB NO.
PITS AND/OR DRAINFIELD @ 510.00 CO.IMP.NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. G.
PRIVATE DISPOSAL SYSTEM @ $3.00 O
CONNECT ADDITIONAL BL�QG-OR AFFIDAVIT WAIVER -EASEMENT RECORD.INSTR.NO. DATE V
WORK TO HOUSE SEWER fr9M6-
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL. $5.00 /-� �.J`
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O L ` .(�IG2 OR
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT W
MANHOLE PERMIT NO. a
$7.00 N
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ CHARGES
AUTHORIZATION1 TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTORTO 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
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,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 ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR ��MLEGAL OWNER OF, AND INTEND TODISCONNECT PLUG AND
RESIDE IN, THE ED REST TIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE i BACKFILLS EPTIC-TANKS ❑RMTTTEE /� -
SEEP.PIT(S) ❑ CESSPOOLS ❑ ,,.
VALIDATIONCK.. M•0. DASH
Q V-