HomeMy Public PortalAbout9476 LAS TUNAS DR_Sewer__ 6A64 5-65 APPLICATION FOR PERM11
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT-OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION * BUILDING
• JOHN A. LA�1BIE, County Engineer ADDRESS
�
COLEMAN W. JENKINS,SuP't. of Building '
LOCALITYfA f.',.7 1.,` ;"''•
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.; -
'I LEGAL".
'DESCRIPTIO LOT NO. OWNER ' ., F"� •.,t f �/' �•#{i+. b�`4.a. f`.
MAIL
ADDRESS
''BLOCK TRACT _
�.
;NO. OF BLOGS. -c( `
SIZE OF LOT NOW ON LOT CITY FLI�E OF
q J.:j �'• �_1n TEL. NO. .-4 roti }'»• +«'S y�
B ILDINGS .i + 14 ...e' DISTRICT NO. GROUP MAP - PROCESSED BY
BK PG
CONTRACT•OR�-rti
_. �• � fid'• ,;+�,�s�'��'.
` CONNECTIONfDATA
ADDRESS a.J ♦. t ? �. r°�'- 4.-)'.J t t,t ars ,.v .,,. ,}
STATION
r. r - a—DEPTH
CITY' J') TEL. :{ *
LICE.JSB `` �t - LICENSE '` - UPPER
MANHOLE REFERENCE
NO_;�, °`i CLASS `Cd4o*T - \,; LOWER•».
NO GESCR PTI'ON OF WORK FEE TYPE OF CONNECTION LENGTH FROM
�HOUS�E SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. A
PUBLIC.SEWER C $ 5:00 - _ P.C.NO. O
SEPTIC TANK,—SEEPAGE GE PIT OR CO. IMP. NO. JOB NO. V
PITS AND/OR DRAINF IELD C $1c).00
- - -
H SEWER CONNECTING T
rUSE G COECIO TRUNK PERMIT ND. ROAD PERMIT NO. J
PR.I VATE DISPOSAL SYSTEM !' $ 3.00
•
CONNECT,ADDITIONAL BLDG. OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR:NO. DATE.
WORK TO,H`bUSE'SEWER C $ 3.00 "
REPAIR O{7"'. AND N - -
SE W E R OR DISP O C $ 3.00
T HWY.OR ST.WIDENING
EXT•N.,CESSPO OL:, MANHOLE C $ 5.00 O
STATE ENCROACHMENT
`PERCOLATION TEST .� C $ 5,00 PERMIT NO. d
INDUSTRIAL y
WASTE APPROVAL F—
OWNERS PERMIT S 2 OO CHARGES
CONNECTION CHARGE FEE
1AUTHORIZATION TOTAL 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 INSPECTOR'S SIGNATURE
SIGNED TV`I$? `� "`DAY OF
OWNER OR {;;f ' NEW HOUSE SEWER
OWNERS AGNTd
CONNECT ADDITIONAL
/'• - BUILDING OR WORK -
ADORESS .:_I i"`.'*; "." 1 ....W '.{f," .= d.f�,�4.f
- SEPTIC TANK.SEEP,PIT('S)
I' HEREBY ACK NOW LEDG ETH AT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
,AND STATE THAT`THE ABOVE IS CORRECT ANDAGREETO COMPLY
WITH RILL COUNTY ORDINANCES AND STATE' LAWS REGULATING PLUMB] ND.+SEWER9. CESSPOOL ❑ DRYWELL ❑
i /
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS-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. I.N,j'THE ABOVE DESCRIBED ESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
S I G NATO RE •,OF.PERMITTEE J` a t "�"'3'rw-.r:, JSBACKFILL SEPTIC TANKBEE P,.PITS) ❑ CESSPOOLS ❑
VALIDATION
>f•CK, M.0. CASH -
�,.,, P
f