HomeMy Public PortalAbout9422 LAS TUNAS DR_Sewer__ E80e.0
Ce•ss M " •- .APPLIC�ATI�ON-• FOR ,PERMIT
EeoCOUNTY OF•LOS..ANGELES
_ SEWER=SEWAGE DISPOSAL.
DEPARTMENT-OF COUNTY'ENGINEER
BUILDING AND SAFETY-DIVISION TBUILDING, _
JOHN A.LAMBIE, County.Engineer' ADDRESS
CASSATT D. GRIFFIN, Supt of Building LOCALIT '" ( "
NEAREST u
FOR APPLICANT TO FILL IN cRoss sr.
LEGAL' � y pp,��p 'OWNER
DESCRIPTIO HI LOT NO.. / !�{
BLOCKTRACT•
CoA f ADDRESSL NO OF n >.y- �/
SIZE OF LOT Q NOW ONBLOT S. CITY- a �As1 E TEL.NO, i110r�3
USE OF
BUILDINGS `� I: ►• '_t DISTRICT N0. .GROUP MAP PROCESSED BY '
�� af'` PG
CONTRACTOR ®s 27-
ADDRESS.
7ADDRESS. ' ` '�/ s r---- CONNECTION DATA
CITY ❑ TATIN� pL " DEPTH
REGISTRATION NO. ❑ COUNTY MANHOLE REFERENCE
NO. -- DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 -i0 -
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH FROM
-
SEPTIC
PITS AND/OR DRAINFIELD @ $8.00 Y. CURB P.L.. .L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO IF.C.NO.
_PRIVATE DISPOSAL SYSTEM @ $1.00' CO;:IMP.N04 / T? JOB NO. '
CONNECT ADDITIONAL BLDG.OR TRUNK-PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 `
ALTER,REPAIR OR ABANDON HOUSE . STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
ORAS PERMIT `;$ 2. 00' CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE Qlo REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. ,APPROVALS DATE INSPE TOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ,l
TO THE.PUBLIC SEWER.
SIGNED THIS AY' OF + 19 NEW HOUSE SEWER �?J
OWNER OR ' CONNECT ADDITIONAL,
OWNERS AGENT BUILDING-OR WORK
ADDRESS c A: � SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT, I HAVE AEAD THIS APP GIATIOhI
D
AND STATE THAT'THE ABOVE IS CORRECT ANAGREE 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 AM .THE LEGAL OWNER OF THE ABOVE'
BACKFILL SEPTIC,TANKS❑"
DESCRIBED',RESIDEN A PROPERTY. s. -
SIGNATURE SEEP,.PIT(S) ❑. CESSPOOLS �" r a .,
OF'PERMIT TE T t
®P` VALIDATIO "ROBERT A.WOOD:.
SUPERY181NfoMfiCHAN1CALfiNG31NEER.
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