HomeMy Public PortalAbout9526 LAS TUNAS DR_Sewer__ 76A642D APPLICATI N FOR PE IT
6A64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING -�
JOHN A, LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building_ LOCALITYAkdf (01
NEAREST
FOR APPLICANT TO F= IN CROSS ST.
LEGAL OWNER /
DESCRIPTION LOT N0. G� 46
BLOCK TRACT MAIL
ADDRESS-
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
DISTRICT NO. GROUP MAP PRO SSED BY
BUILDINGS BK PG
CONTRALTO
ADDRES CONNECTION DATA
CI TEL.N0. STATION D t
ATE MANHOLE REFEREN
REGISTRATION NO. COUNTY Ir LOWER
NO. 1 DESCRIfTlON7OF WORK FEE
HOUSE SEWER CONNECTING TO /f'>v '~
PUBLIC SEWER @ $3.00 7 �O PE OF CON CTLENGTH FROM
IO
SEPTIC TANK,SEEPAGE PIT OR CO P.C. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ S2.00 (-
HOUSE SEWER CONNECTING TO CO.IMP. N0. JOB NO.. OV
PRIVATE DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N
WORK TO HOUSE SEWER @ $1.00
ALTER'R FAIR ABANDON
SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT O
SEWERPERMIT NO. u
INDUSTRIAL a
WASTE APPROVAL N
CHARGES ?
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS Y OF )9_ NEW HOUSE SEWER !
CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I. 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 DISPOSALSYSTEN
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES, AL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE G' SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
VALIDATIOCASH ROBERT A. WOOD
CK. M.0. SUPERVISING MECHANICAL ENGINEER