HomeMy Public PortalAbout9518 LAS TUNAS DR_Sewer__ ,0.62
76A6AB42D APPLICATION FOR PERMIT
84
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING - 0
ADDRESS S T��/S ��
JOHN A. LAMBIE, County Engineer f'JQ
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST r+�
FOR APPLICANT TO FILL IN CROSS ST. �AS/ fEe. �t�
LEGAL
-'S / 'A
DESCRIPTION LOT NO. {,,.0 OWNER ��ff/
MAIL
BLOCK TRACT �j ADDRESS
NO. OF BLDGS.
SIZE OF LOT Nt7W ON LOT / CITY TEL. NO.
USE OF _
BUILDINGS � DISTRICT NO. Ta MAP CESSED BY
�q L/ ,� BK PG
CONTRACTOR ligcc L/COAj P.-4 J -R(rPOOL AiliC6 � /
7 �
ADDRESS it-/S♦r' �A/`/1 40/Dde!' CONNECTION DATA
CITY 4i L TA.n/E.a/'A-
TEL. NO. V V y 7:►'� ' STATION za )))��l JJJ DEPTH,I
REGISTRATION NO. !. /7�I / COUNTY MANHOLE REFERENCE •/4 '/]/� LOWER d
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION �(,' LENGTH FROM O
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. V
PUBLIC SEWER $5.00 O(7 P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO. '31V JOB NO. O
PITS AND/OR DRAINFIELD @ $10.00 G
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00 (JJ
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIIER I EASEMENT RECORD.INSTR.NO. DATE d
WORK TO HOUSE SEWER @ $3.00 N
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXT N.,CESSPOOL,DRYWELL,MA NH OLE @ $5.00
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'SPERMIT s 2 00 '
AUTHORIZATION TOTAL FEE 0 CONNECTION CHARGE FEE
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 INSPECT R'S SIGNATURE
SIGNED THIS�DAY OF /- 9�� �//
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
"BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP.PIT(S)
1. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD ..
AND STATE THAT THE ABOVE 15 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 ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT M THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB BE4 RES�IPROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTE SEEP,PIT(S) ❑ CESSPOOLS Ell
VALIDATION ROBERT A. WOOD
M.O. CASH
SUPERVISING MECHANICAL ENGINEER
CK. -
L'CO
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