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HomeMy Public PortalAbout9508 LAS TUNAS DR_Sewer__ CE808=8.58 8D - "APPLICATION FOR PERMIT. CEBo8 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS !> Q t JOHN A. LAMBIE, County Engineer- - - CASSATT D. GRIFFIN, Sup'f of Building LOCALITY f NEAREST FOR APPLICANT TO FHl IN crtoss sr. LEGAL OWNER DESCRIPTION LOT N0. BLOCK TRACT MAIL �• _ ADDRESS K NO.OF BLDGS.. SIZE OF LOT. $A ® NOW ON LOT CITY TEL.NO. USE OF. - BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY �J BK P6' CONTRACTOR /✓ ADDRESS CONNECT ON DATA CITYTEL.N0. STATION �a DEPTH ¢. STATE MANHOLE REFERENCE UPPER REGISTRATION NO. ©� COUNTY NO. DESCRIPTION OF WORK FEE zy HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 Y. CURB L. M.L.TO P.L. Zg 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 TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1.00 ALTER, REPAIR OR ABANDEM ON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYST@ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS, PERMIT $ -2 00 CONNECTION CHARGE FEE a:• AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE' TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r TO THE PUBLIC SEWER. SIGNED THIS �'�' n Y OF Igg NEW HOUSE SEWERa OWNER OR CONNECT ADDITIONAL `'•+•.�. :.-.-1 OWNERS AGENT BUILDING OR WORK SEPTIC TANK,SEEP, PIT(S) ` ADDRESS AND/OR DRAINFIELD. - 1 HEREBY ACKNOWLEDGE 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 LAWS REGULATING ALTER-,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE`DISPOSAL SYSTEM I HEREBY CERTIFY THAT AM PROPERLY REGIST D AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED LOS ANGELE )UNT ND STATE OF CALIFORNIA OR THAT AM THE L N OF THEjA ; ABANDON HOUSE SEWER e DESCRIBED RESIDENT ROPERTY. BACKFILL SEPTIC TANKS❑ Ile SEEP.PIT. S) ❑ CESSPOOLS' + e a SIGNATURE .- OF PERMIT TE IF L-L Or. ' . ATI O ROBERT A.WOOD . SUPERVISING MEGHANIGAL ENGINEER