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HomeMy Public PortalAbout9423 LAS TUNAS DR_Sewer__ 76q„8 da{;;� CE808-10-71 APPLICATION FOR PERMIT L(J COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS "'r 7, A 1,'7 LOCALITY �• 4f/77 NEAREST ' FOR APPLICANT 'TO FILL IN CROSS ST. LEGAL C / DESCRIPTION LOT NO. '� OWNER •� MAIL BLOCK TRACT ADDRESS L Gi NO, OF BLDGS, SIZE OF LOT Q NOW ON LOT CITYZ=Q EL.,NO. USE OF BUILDINGS j.' DISTRICT NO. GROUP I MAPPROCESSED BY BK PS CONTRACTOR .0 A• �•©� L.... �� �p• _ _ ADDRESS CONNECTION DATA A STAT10 DEPTH CITY TEL. NO. - (i STATE LIC LICENSE NO. GLASS �MANHOLE REFERENCE UPOWERPER NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION L GTH FROM HOUSE SEWER CONNECTING TO Y. CURB :L. M.L.TO P.L. PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AN D/OR DRAINFIELD @ $10.00 CO. IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 4. PRIVATE DISPOSAL SYSTEM' @ $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER 1111MCNT RECORD,INSTR,NO. DATE 0 WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD OC EXTN..CE S SPOOL.DRYW -�� $5.00 HWY.OR ST.WIDENING O ALTER.REPAIR BANDON HOUSE /y SEWER OR DISPOO A $3.00 vo STATE ENCROACHMENT _ W MANHOLE - @ $7.00 'PERMIT NO. d INDUSTRIAL W WASTE APPROVAL _z OWNERS PERMIT s s o0 CHARGES AUTHORIZATION TOTAL FEE 60 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 ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ WITHALL 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 LICENSEDAS REQUIRED BY LOS ANGLE COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL NER OF, AND INTEND TO UG AND p/ RESIDE IN, THE ABOVE DLRIB ED RE ENTIAL PROP RTV. Ig /) 'ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PER MTTTEE SEEP.PIT(S) ❑ CES POOLS ❑ VALIDATION CK. M,O. CASH