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HomeMy Public PortalAbout9516 LAS TUNAS DR_Sewer__ 76A 642D-CE808 -10-71 APPLICATIOTI FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION F �+j�L/ J/ !S "`FOR APPLICANT TO FILL IN . `A- /' AL DESCRIPTION LOT NO. 680 OWNER , lay /"/ (/ MAIL BLOCK TRRAA�C�T 6-5-61` ADDRESST�// 'J SIZE OF'LOTp2� 7eI1U NOWON LOT CITY / [ Ol (oj' NO. ( ��7 USE OF Df DISTRICT N0. GROUP MAP OCESSED BY BUILDINGS 4 �) BK PG 60NTRACTOR ADDRESS / Oet5o [D �f C - CONNECTION DATA�/ ZA CITY ATEnn �J LyT►E L. NOS/ •� 0/°' 2 STATION �7�� ,fys DEPTH / a LICENSE NO.. S�J CLASS (� 9J, UPPER MANHOLE REFERENCE „+J��a NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM ,f � HOUSE SEWER CONNECTING TO ,00 Y. CURB P:L. M.L.TO P.L. ` PUBLIC SEWER @ $7.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ SIO.00 - CO. IMP. NO. JOB NO. 312 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d PRIVATE DISPOSAL SYSTEM @ S3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAIVEN -ens[M[xT REC ORD. INSTR.NO. DATE U WORK TO HOUSE SEWER @ S3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD CC EXTN..CESSPOOL.DRYWELL. @'S5.00 HWY.OR ST.WIDENING 0 ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT W MANHOLE@ $7 00 PERMIT NO. d INDUSTRIAL N WASTE APPROVAL OWNERS PERMIT $ 3 00• CHARGES /TOTAL FEE 0 ©0 CONNECTION CHARGE FEE AUTHORIZATION 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 INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER • 4 OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THI5 APPLICATION AND/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 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 IN, THE ABOVE E t'BED RESIDENT PROPERTY. ABANDON HOUSE SEWER SIGNATURE - OF PERMTT,T• e l BACKFILL S2P -iYhTfPS'Q CESSPOOLS ✓ 7� ,,.�- VALIDATION CK. M.O. CASH 6451t"Zid2010D 10.00 w