HomeMy Public PortalAbout9523, 9525 LAS TUNAS DR_Sewer__ N
S&E-6D69 11.55 APPLICATION FOR PERMIT 1
S E•8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING .r
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS S• /��S �UAJ..A,�
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 4Pv1/��,� C
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. /du✓`
LEGAL OWNER LOT NO. �
(
MAIL
BLOCK TRACT / ADDRESS �„� � 7t,t, $'
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USE OF C
BUILDINGS d DISTRICT NO. GROUP MAP
a
� BK PG
c� / E �
CONTRACTOR CIO C /
ADDRESS Z S' f., r x ,� C/►ONMCTION DATA
TEL. NO. STATION � DEPTH
CITY f UPPER
/ MANHOLE REFERENCE
C'�
REGISTRATION NO. ! g'� ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTIO LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50 �v
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C'. NO.
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. NO.I g JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. .ROAD PERMIT
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHM NFT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL .�
SEWER OR DISPOSAL SYSTEM @ $.1.00 WASTE APPROVAL
��" CHARGES
CONNECTION t RGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE S a
I HAVE'AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• APPROVALS DATE INS.ECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEW ,p NEW HOUSE SEWER !�
SIGNED THIS DAY OF O-I 41 195 1 CONNECT ADDITIONAL
OWNER OR - - BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS 9-/ ,G ti aQ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY JLOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 THE LEGAL 0 R OF THE ABOVE
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. PIT(S) C3 CESSPOOLS❑
- -
OF PERMITT
E
JOHN A. LAMBIE, CO NTY ENGINEER r yALIDATION ROBERT A.-WOOD, CHIEF PLBG. INSPECTOR
CK. ) M.O. CASH -
0 5 7 2 6 4 14AR 4 . 4 4.5 0 �'