HomeMy Public PortalAbout9475 LAS TUNAS DR_Sewer__ 76A 6V°'= CE808 - 9"3. APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 4 E /Las Tunas
LOCALITY Temple City
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FOR APPLICANT TO FILL IN CROSSsST.
LEGAL Wi nchel 1 Donuts
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS
O. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICTNO. GROUP MAP PRO SSED BY
BUILDINGS BK PS
CONTRACTOR Joseph Cad i 1 1 i Plumbing
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ADDRESS $ -Garvey Ave CONNECTION DA
CITY Rosemead TEL. NO. 2VO-42D1 /
STATION �y ¢ . rd DEPTH
STATE MANH REFE , e1 t3 7 UPPER
LICENSE NO134935 CA.. C36 OL .,,J'•.a OWE
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TOY.
nf� Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7-00 �Q,aI
SEPTIC TANK.SEEPAGE PIT OR i ,e P.C.NO.
PITS AND/OR DRAINFIELD $10.00 CO.IMP.NO. J JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM Q $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDATIVEE EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER Q $3.00 CL.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL. @ $5.00 V
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
(--
MANHOLEPERMIT NO.
Q $7.00 LLI
INDUSTRIAL O.
WASTE APPROVAL N
Z
OWNER'S PERMIT $ CHARGES
AUTHORIZATION TOTAL FEE >S ef) CONNECTION CHARGE FEE
1HAVE 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 'bF�/ •A"'ay"`
OWNERS AGENT CONNECT ADDITIONAL F
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THISAPPLICATIONAND/OR DRAINFIELD
AND 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 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER ORCE
LINSED AS REOUI ED BY LOS ANGLES COU TY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL(FC.NIA OR TH I AM THE LEGA OWN F� AND INTEND TO - DISCONNECT PLUG AND
RESIDE IN, THE A E DESCRIBED SID TI,��PR ERTV, ABANDON HOUSE SEWER
SIGNATURE q BACKFILL SEPTI TANKS ❑
OF PERMITTEE ❑
} SEEP.PIT(S) SSPOOLS
VALIDATI CK. M:O. CASH
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