HomeMy Public PortalAbout9464 LAS TUNAS DR_Sewer__ 7GA642D APPLICATION FOR PERMIT
.CF-808 11-57 COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL- ,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING' OC;V 41
�-
JOHN A. LAMBIE, County Engineer ADDRESS -
CASSATT D. GRIFFIN. Sup't of Building LOCALITYNEAREST
J/
FOR APPLICANT TO FILL IN CROSS ST. "' 6
LEGAL 'J
DESCRIPTION LOT NO. �� OWNER /�}��t�
BLOCK TRACT 5-5� ,� MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT - NOW ON LOT CITY - •TEL.NO.
USE OF
BUILDINGS r / DISTRICT NO. GROUP I MAP
CONTRACTOR j _ ����� K - PG
ADDRESS CONN CTION DATA
CITY TEL.N0. �,.._ STATION ,.' _ DEPTH
>'..
STATE- MANHOLE REFERENCE UPPER
REGISTRATION NO. 1ry CIZ / (oma-ej/2. ❑ COUNTY •r
NO. 1 DESCRIPTION OF WORK FEE —_
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3'.^59-
TYPE OF CONNECT LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. .CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 _
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. , / JOB NO.
CONNECT ADDITIONAL BLDG.OR T�
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2L 00 CONNECTION CHARGE FEE
AUTHORIZATION 1, TOTAL FEE f REIMBURSEMENT FEE
1 HAVE AT.THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPEC�7tOR�SSIGNATU RE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR _ ` _ - CONNECT ADDITIONAL - - - - - - - '
OWNERS AGENT 1 BUILDING OR WORK
ADDRESS - - - SEPTIC TANK,SEEP,PIT(S) - - - - - :-
AND/OR DRAINFIELD
I HEREBY ACKNOW EDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO, COMPLY CESSPOOL ❑ DRYWELL❑ -WITH ALL COUNTY ORDINANCES AND STATE LA:M'REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
1-HEREBY CERTIFY THAT I AM PROPERLY REGISTERED-'AND/OR SEWAGE DISPOSAL SYSTEM - - - -.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWN/ER OF THE ABOVE ABANDON HOUSE SEWER f�A
DESCRIBED RESIDENTI L ROPERTY. 4! 1 BACKFILL SEPTIC TANKS ❑ ^'__�C.i4'
SIGNATURE / v - �! SEEP. PIT(S) ❑ CESSPOOLS / O
OF PERMITTEE'+
®r - - -VALIDATION - -ROBERT A. WOOD
CK nf.0. CASH SUPERVISING MECHANICAL ENGINEER
U&1 4 '7 7 01 DEC 31 0 A 5.a 0 A.