HomeMy Public PortalAbout9432 LAS TUNAS DR_Sewer__ s&E-6 311.55 APPLICATION` FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I-S POSH L
Department of County Engineer
County of Los Angeles BUILDING
JOHN A•. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D:GRIFFIN, SUP'T.OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.-
LEGAL _. OWNER
DESCRIPTION LOT NO. '
MAIL
BLOCK TRACT ADDRESS /
NO.OF BLDGS. - CITY t TE , N0.
SIZE OF LOT .NOW ON LOT
USE OF DIST CT-NO. GROUP MAP
BUILDINGS.. BK PG.
CONTRACTOR
- CONNECTION DATA
ADDRESS -
CIT TEL. NO.
STATION �l J DEPTH
MANHOLE REFERENCE / -- }�-� -
ST ITE '♦ s3 Tr<".! LOWER
REGISTRAT N /� ❑ COUNTY
NO. DESCRIPTION OF W Rt FEE
TYPE OF CONNECTIOI�a LENGTH FROM
HOUSE SEWER CONNECTING TO r Y. CURB - P.L.T� M.L. TO P.L.
PUBLIC SEWER @ $3.50 _
SEPTIC TANK,SEEPAGE PIT OR - -
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P..C. NO. -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. / � `)OB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM-- @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER @ $1.00' PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE_ INDUSTRIAL .
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL' -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ t 00
REIMBURSEMENT FEE. -
AUTHORIZATION TOTAL FEE )
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- - APPROVALS DATE INSPECTORS SIGNATURE,
TRACTOR TOCONNECTTHE ABOVE DESCRIBED EXI TING DWELLING -- �
TO THE PUBLIC SE E NEW HOUSE SEWER
SIGNED T H IS DAY A IJrl� CONNECT ADDITIONAL I
OWNER OR, - BUILDING OR WORK - -
OWNERS A. SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGEY THAT AVE RED IS APPLICATION CESSPOOL❑ DRYWELL❑
'
AND STATE THAT THE ABOVE IS RE CT ANDAAGREE TO GOMPLY _
WITH ALL COUNTY ORDINANCES ND STATE LAIRS 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 E11UIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
LIFORNIA. _THAT 1. At
THE EGAL OWNS- OF T E AB'O -
D C IB R NTI R PERT BACKFILL SEPTIC TANKS
SEEP. PI?(S) ❑•CESSPOOLS ).Z ,.,�7 A.� •«-,.c.
S Tt t
F hall,! E
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION- ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
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CK. M.