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HomeMy Public PortalAbout9503 LAS TUNAS DR_Sewer__ CE808A 4'72 APPLICATION FOR PERMIT 76 A642L u COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS , _S' r LOCALITYNEARE /� FOR APPLICANT TO FILL IN. CR.SSSST. LEGAL yy spy A. DESCRIPTION LOT NO. �/ y •� �i,, OWNER �/,�—'-L_ J yr 45d MAIL j BLOCK TRACT • : ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS / /,r ` / �.l BK PS q} CONTRACTOR .f ✓ K•)[/� S -f!� j �O , ADDRESS '7,? -r4 , CONNECTION DATA CITY �Q�i ,(, TEL. NO. 7 2 A� STATION /,� � / DEPTH I STATE j] /[- g�>•'-may LIC R' MANHOLE REFERENCE / Ute. LICENSE NO. y T 'L/ GLASS [s r NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION ~LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB .L'. M.L.TO P.L. PUBLIC SEWER @ d SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ CO.IMP. NO. .3 - JOB NO. 0 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ CONNECT ADDITIONAL BLDG.OR 4? AFFIDAVIT WAIVER EASEMERT RECORD, INSTR,NO. DATE O WORK TO HOUSE SEWER @ 1 OVERFLOW SEEPAGE PIT.DRAINFIELD V EXTN.,CESSPOOL.DRYWELL,MANHOLE @ LLI ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING d SEWER OR DISPOSAL SYSTEM @ STATE ENCROACHMENT z PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $1 3 10-d AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED//CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ p OWNER OR NEW HOUSE SEWER OWNERS AGENT / CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK. PIT(S) AND/OR DRAINFIFIELEL D AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY , WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 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 M THE LEGA OW F AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DESCRIBED 5 ENTI L ROP TY. ABANDON HOUSE SEWER SIGNATURE �7 BACKFILL SEPTIC TANKS ❑ OF PERMTTTE SEEP.PIT(S)-❑ CESSPOOLS ❑ MIDATION .0. CASH RAR 1`8.1 U U 6,0,0 A-96 • � CIS� -�' ����- Co� � - ,z 76A -BB APPLICATIOy No- FOR PERMIT 76A 8420 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER /1 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 DESCRIPTION LOT NO. G 7 G. Z9 G�JO •.Z� OWNER MAIL C BLOCK TRACT (0 ADDRESS�3® NO. OF BLDG S' SIZE OF LOT NOW ON LOTCITY ♦ TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY P6 r CONTRACTOR d IADDRESS (?Q CONNECTION DATA TEL. NO.LI(� pSTATION O J. Q DEPTH ' STATE LICENSE NO: LCILAC'S ©T% MANHOLE REFERENCE � LOWER �60S NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION ` LENGTH FROM / HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P.L. PUBLIC SEWER @ $5.00 / P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. / JOB NO. PITS AND/OR DRAINFIELD C $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG,OR AFFIDAVIT I WAIVEI EASEMENT RECORD,INSTR,NO, DATE CC:) WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD d' EXTN.,CESSPOOL.ORYWELL.MANHOLE @ $5.00 0 Tcn-i.v�W OR ABANDON HOUSE HWY.OR ST.WIDENING V SEWER @ $3.00 ® STATE ENCROACHMENT Lu PERMIT NO. C/J INDUSTRIAL Z WASTE APPROVAL OWNERS PERMIT $ 2 00 S CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A .CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE - TRACTOR TO-CONNECT THE ABOVE DESCR ED EXISTING DWELLING TO THE PUBLIC BE APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS D .0 ^ 19_ OWNER OR -o. NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL r )ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT,I HAVE READ THIS APPLICATION A-ND�OR DRAINFIELD AND STATE THAT THE ABOVE I5 CORRECT AND AGREE TO COMPLY WITH ALL 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 LICENSED AS REQUIRED BY LOS ANGL COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGA WNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCR D R 4DENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE n OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION_ M R. ALLEN CK. M.O. C,r' � SUPERVISING NG MECHANICAL ENGINEER CASH