HomeMy Public PortalAbout9557 LAS TUNAS DR_Sewer__ �t
CE808.3-.62 ICATION� FOR PERMIT 76A642D MF
COUNTY-OFGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING_AND SAFETY DIVISION- BuILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JEN KINS, SUPT. of BUILDING LOCALIT-Y t
NEAREST
FOR-APPLICANT TO FILLS IN1 `ROSS ST.LEAL
DESC RGPTIONf;? L�OjT'NO. ` OWNER (/" �.
MAIL
BLOCK TR CT l ��1� ADDRESS vVP
NO. OF BLDG..
SIZE O LOT NOW ON LOT CITY .`♦ TEL. NO.
USE OFDISTRICT NO GROUP MAP PRO ESSED BY
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BUILDINGS � � ��`
�q/� BK PG
CONTRACTOR If cc)
V T /�
ADDRESS -727—A. 0 0 u y tCONNECTION DATA
CITYgj& Ct - TTEL. NO9,. & - Y -Z) STATION .0 DEPTH. �
STATE C 'Gf U CLASS �- M4NH OLE REFERENCE LOWER`� (
LICENSE NO,_ �J /•
NO. .DESCRIPTION OF WORK' FEE TYPE OF CONNECTION LENGTH FR M IF
HOUSE SEWER CONNECTING TO Y. CURB P.L. _ .M.L.jO,P.L ':5 a
PUBLIC SEWER - - @-.55.00F
-•85.00 �. � - O
SEPTIC TANK,SEEPAGE PIT OR '✓J/ PA.NO.
PITS ANO/OR DRAINFIELD @ 810.00 CO.IMP.-NO.. JOB NO. V
HOUSE SEWER CONNECTING TO � O
TRUNK PERMIT NO. ROAD PERMIT NO. / fir/
PRIVATE DISPOSAL SYSTEM @ 83.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD,INSTR,NO. DATE F-
WORK TO HOUSE SEWER 83.00. W
OVERFLOW SEEPAGE PIT.DRAINFIELD - a
EXT N..CESS POOL.DRYWELL.MANHOLE @ 85.00
ALTER..REPAIR OR ABANDON HOUSE HWY..OR STJWIDENING
SEWER OR DISPOSAL SYSTEM @ 83.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
1" � CHARGES
OWNERS PERMIT $ i 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED.THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ _ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 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 ❑
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER, REPAIR.SEWER OR
LICENSED AS, REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGEtD ISPO SAL SYSTEM -
CALIFORNIA'OR THAT I AM THE :EGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE'ABOV E DES R ED' RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE �. (lJ' BACKFILL SEPTIC TANKS •❑
OF PERMTTTE v/ SEEP.PIT(S) J❑, CESSPOOLS ❑
VALIDATIO;�/"�_ JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
.. ... .. � .. .. ..CK. ... ..M.O.Vi�ss. 7 CASH
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