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HomeMy Public PortalAbout9427 LAS TUNAS DR_Sewer__ 76A 642D TCFJ06-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DI'SPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS LOCALITY' NEAREST FOR A'PPLICAN�T' TO FALL IN CRDes eT. LEGAL DESCRIPTION LOT NO. OWNER Y MAIL BLOCK TRACT. ADDRESS NO, OF BLDGS. �j SIZE OF LOT © ! NOW ON LOT J CITY ,� ��TEL. NO. USE OF y.. BUILDINGS �. / - DISTRICT N0. GROUP _BK MAP p, PROCESSED BY CONTRACTOR � ADDRESS CONNECTION DATA CITY Z TEL. NO. ,.S ' ��` STATIONDEPTH STATE LIC ✓ \ RE ^^----�� /�, i UPPE LICENSE NO:, CLASS �r/ MANHOLE REFERENCE �!lr /�_� ! t OWER NO. .DESCRI'PT ON OF WORK FEE TYPE OF CONNECTIO T� LENGTH FROM / HOUSE SEWER CONNECTING TO Y. CURB P. M.L.TO P.L. PUBLIC SEWER • @ $7.00 SEPTIC TANK.SEEPAGE PIT- OR P.C.NO. PITS AN D/OR.DRAINFIELD @ '510.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d PRIVATE DISPOSAL SYSTEM @ S3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -EASEMENT RECORD.INSTR.NO, DATE V WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD CC EXTN..CESSPOOL.DR LL-_ @ $5.00 HWY. OR ST.WIDENING O ALTER,REPAIR OR BANDON ,�E {- SEWER OR DISPOSAL SYSTEM @ $3.00 V STATE ENCROACHMENT W PERMIT NO MANHOLE . @ $7.00 N INDUSTRIAL WASTE APPROVAL Z OWNER'S PERMIT s s 00 CHARGES CONNECTION CHARGE FEE QV AUTHORIZATION TOTAL 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 TANK,SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/ R DRAINFIELD _ AND O 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 REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT �;AM THE LEGA OWNER OF, AND INTEND TO DISC ONNEC RESIDE IN, THE ABO D CRIBED SIDENTIAL PROPERTY. ABANDON QUSE SEW ER SIGNATURE. , BACKPILL SEPTIC TANKS El - OF PER MTTTE SEEP.PITS ESSPOOLS ❑ VALIDATION I 4K. I M..D. CAS" l