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HomeMy Public PortalAbout9470 LAS TUNAS DR_Sewer__ �62 76AG42D APPLICATION FOR PERMIT - 6A642 � LJ COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER / BUILDING AND SAFETY DIVISION rNEAREST UILDING / ��S V rlti�$ JOHN A. LAMBIE, COUNTY ENGINEER DDRESS / V COLEMAN W. JENKINS, SUPT. OF BUILDING J/ OCALITY yy FOR APPLICANT TO FILL IN ROSS ST. f� LEGAL DESCRIPTION LOT NO. ` �� OWNER �S 3�aY MAIL BLOCK TRACT ADDRESS NO, OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS p/ ,1��'^ BK PG CONTRACTOR L,.' (•r/S �.�d P - 14 ADDRESS �" CONNECTION DATA/ii���� CITY r'SATEyy TEL. NO, f��/.a STATION Ze DEPTH LIC LICENSE NO; 3/ t...+ 6*L SS X34 MANHOLE REFERENCE , / / G LOWER NO. .DESCRIPTION OF WORK FEETYP NECTION LENGTH F OM j,lrHOUSE SEWER CONNECTING TO Y. URB P.L. M.L.TOP a PUBLIC SEWER @ $5.00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. O NO. .10B PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. fY PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD,INSTR. WORK TO HOUSE SEWER @ $3.00 (,J OVERFLOW SEEPAGE PIT,DRAINFIELD Lu EXTN..CESS POOL.DRYW ELL.MAN H OLE ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING byy SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT s 2 00 AUTHORIZATION TOTAL FEE ® CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER / 1. OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL 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 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE//DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE AI� BACKFILL SEPTIC TANKS ❑ OF PERMfTTEE Y/' SEEP.PIT(S) ❑ CESSPOOLS ❑ ^VALIDATION TACK R. ALLEN SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH LAC0.5 3 0 5-Go .tint. 2 1 0 D 7.0 0.1 CEBOB 3.62y APPLICATION FOR PERMIT 78A842D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL u_ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �; 7a JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING /J LOCALITY _ l'{. NEAREST FOR APPLICANT TO FILL IN `ROSS ST. LEGAL DESCRIPTION LOT NO. ® �} OWNER �� �y MAIL BLOCK TRACT ADDRESS NO. OF BLOGS. SIZE OF LOT NOW ON LOT CITY TEL, NO. USE OF DISTRICT NO. GROUP MAP P OCESSED BY BUILDINGS BK P. CONTRACTOR ADDRESS l� i sr. f� /� , CJO�NNECTION DATA CITY �V e;V TEL. NO.,34/ .9of4'® T TION /( DEPTH}c� STATl•� / UPPER LICENSE NO;. GLA.. ( NO. .DESCRIPTION OF WORK FEE TYPE OF ON F TION_PGTH OM HOUSE SEWER CONNECTING TO Y. R P. .L.TO L. a _ UBLIC SEWER @ $5.00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. O PITS AND/OR DRAINFIELD @ $10.00 CO. IMP. NO. ,� JOB N0. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. iw PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR4,61AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE V WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD Lu E XTN..CESSPOOL.DRY WELL.MAN HOLE C $5.00 a' ALTER,REPAIR OR ABANDON HOUSEHWY.OR ST.WIDENING ' SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT z PERMIT NO. INDUSTRIAL WAST ROYAL / CHARGES OWNERS PERMIT s 2 00 AUTHORIZATION I TOTAL FEE '/) CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE IN CTOR'S SIG ATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER �p OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING Yee PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ l A I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER 1/ SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMfTTEE SEEP.PIT'S) ❑ CESSPOOLS ❑ OCKM.ALIDATION JACK R. ALLEN 0. CASH SUPERVISING MECHANICAL ENGINEER M.O. CASH 0.1 LACO 5 :5 0 6"US ,yin. 2 1 0 D 1 6.0 0— 76AS42D APPLICATION FOR PERMIT 6A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL �_ J DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST, LEGAL ,/� ©/•I/-� ' syr DESCRIPTION LOT NO. .�� OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDG$. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR C ��� �✓ / /4 ./�6.t_/ ♦�/ J. ADDRESS CONNECTION DATA CITY n�yl TEL. NO. Sf ION // G, DEPTH PER STATE LIC y� 3 CLASS C �. MANHOLE REFERENCE V �{ f • UP LICENSE NO,. �J „/ Lr NO. .DESCRIPTION OF WORK FEE TYPE F �1 ECTION f/pLENGT FROM HOUSE SEWER CONNECTING TO Y. C L. M.L.T P.L. PUBLIC SEWERCL @ $5.00 P.C.NO. O SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD �° $10.00 CO. IMP.NO. 3 JOB NO. u HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. IY PRIVATE DISPOSAL SYSTEM @ S3.00 CONNECT ADDITIONAL BLDG.OR O AFFIDAVIT wAIVEN EASEMENT RECORD.INSTR.NO. DATE 0 WORK TO HOUSE SEWER @ $3.00 u OVERFLOW SEEPAGE PIT.DRAINFIELD Lu EXTN.,CESSPOOL.DRYWELL.MANHOLE @ $5.00 d ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING 9 SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT �G� J c0 PERMIT NO. Ir V INDUSTRIAL / WASTE A OVAL CHARGES OWNERS PERMIT s AUTHORIZATION I TOTAL FEE 0 _6 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 INSPEC R'S SIGN TUBE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGEOISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE d BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP.PIT(S) ❑ CESSPOOLS VALIDATION JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH LACO5307�8 JUL 211 D 25.00