HomeMy Public PortalAbout9428, 9426 LAS TUNAS DR_Sewer__ CE808 e - APPLICATI NM- FOR P RMIT .
cEsoa e.sa COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS Z
JOHN A. LAMBIE, County Engineer /I
CASSATT D. GRIFFIN, Sup t of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL
DESCRIPTION LOT NO. J OWNER .,. .�..
BLOCK - 'TRACTMAIL
!m 15�/may ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 'CITY TEL. N0. -
USE OF ' DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS
BK PG I
CONTRACTOR• 71-',,C'
ADDRESS 9ir CONNECTION DATA
STATION DEPTH
STATE REGISTRATI N NO. �GJ -,c (i> ❑ COUNTY MANHOLE REFEREN E UPPER
J i LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION,•'�!`' LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR •Y. CURB P.L.. `'7.`M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD .„,.
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0. _
CONNECT ADDITIONAL BLDG.OR -� TRUNK PERMIT N0. PERMIT N0.
WORK TO HOUSE SEWER - @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT '
SEWER OR DISPOSAL SYSTEM - @ $1.00 PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 2 OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE eA-l2n
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE D . RIBED EXISTING DWELLING .APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.'
SIGNED THISDAY OF 19L ' NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ) l� �- Y'� BUILDING OR WORK _ 3a�o �1'rn.�' ) r
4
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
THEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El o•• SEEP..PIT(S) El CESSPOOLS [IOF PERMITTE 1J -� _�y..r,✓
®PVALIDATION ROBERT A. WOOD
f
CK. M.o. CASK SUPERVISING MECHANICAL ENGINEER .
�� p17061,53 JL!tJ '1. 0d _ 73,.00 .