HomeMy Public PortalAbout9559 LAS TUNAS DR_Sewer__ ieae.asu i'1ft"1`"LICAI ION FOR PERMIT
c`eeos-e se COUNTY•OF LOS ANGELES
SEWER-SEWAGE, ®9SPOSAL 1
DEPARTMENT OF COUNTY•ENGINEER
BUILDING"AND SAFETY DIVISION BUILDING
• ADDRESS. aQ�_. 444 4•/ .
' JOHN A. LAMBIE,_Couaty Engineer "
CASSATT.D. GRIFFIN, Sup't of�Buildiag LOCALITY`' E
.q;
NEAREST' >•
FOR .APPLICANT TO 'FILL IN ceosSST
.
LEGAL OWNER,
-.DESCRIPTION LOT N0.
,MAIL
tl!
BLOCK � TRACT .:
t ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW"ON LOT, "CITY T.EL.N0, '
USE OF
BUILDINGS /l DISTRICT NO. GROUP MAP.' PROCESSED BY.
K' PG
CONTRACTOR
t-
ADDRESS �► - CONNECTION DATA ' -
CITY 'DEPTH459
STATION•
-REGISTRATION NO. 6' / COUNTY MANHOLE REFERENCE c�
STATE / ER
No. DESCRIPTION OF WORK: , FIfE
VV
HOUSE SEWER CONNECTING TO J)
PUBLIC',SEWER @ $3.00' v -
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTI0 LENGTH-FROM
PITS AND/ DRAINFIELD - @ $3.00 :Y. CURB:` P.L.' M.L.TO P.L.
OVERFLOW`SEEPAGE'PIT,DRAiNF1ELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE.SEWER CONNECTING TO* Q P C.NO. '
PRIVATE DISPOSAL SYSTEM '. @ $1:00 CO.IMP.,NO. - 4../ JOB-NO. _
CONNECT'ADDITIONAL BLDG.OR TRUNK'PERMIT N0. ROAD PERMIT NO.,
WORK TO HOUSE SEWER @ $1'.00-
ALTE
R,'REPAIR OOR ABANDON HOUSE-, 'STATE ENCROACHMENT
SEWEROR DISPOSAL SYSTEM' @-•'$1':00... .'PERMIT N0.
INDUSTRIAL._ /
WASTE APPROVAL.'
CHARGES
O �'R'S, ,.? PERMIT' r ' $, 21'`-00 CONNECTION CHARGE FEE
AUTHORIZ,AT_ION TOTAL FEE -,.REIMBURSEMENT'FEE
I HAVE AT THIS DATE.A CONTRACT-WITH?HE HEREIN NAMED CON-: "APPROVAI+S_-. - DATE' INSPECTOR'S SIGNATURE
TRACTOR-TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
,TO THE PUBLIC SEWER. HODS //
SIGNED THIS AY OF I. - NEW E-SEWER 4�= ` o : '
OWNER'0,R - CONNECT,ADDITIONAL -
OWNERS AGE it"' BUILDING OR WORK
ADDRESSr`. - SEPTIC•TANK„SEEP,'PIT(S) - -, -
AND/OR DRAINFIEL•D'
'I,HEREBY ACKNOWLEDGE THAT rL 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-DR
PLUMBING- AND SEWERS. - - SEWAGE DISPOSAL SYSTEM - - -
I HEREBY CERTIFY THAT I AM -PROPERLY*-REGISTERED-.AND/ ISCONNECT.PLUGAND.
.LICENSED AS REQUIRED BY 'LOS ANGELES.COUNTY AND STAT F' ABANDONHOUSE�SEWER, '•,:
CALIFORNIA OR 'THAT I AM THE LEGAL OWNER OF THE OVE
DESCRIBEDRESIDEN IA - ROPERTY. _ - BACKFILLSEPTIC TANKS-0'
SEEP.'PITS
) E] -CESSPOOLS'❑
SIGNATURE.
OF PERMITTEE
®F i:." YAII ATI O
a ta. CAstI S -ERVISING MECH AkirAL SNOINEER