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HomeMy Public PortalAbout9560 LAS TUNAS DR_Sewer__ 6A6:2D-62 7APPLICATION FOR PERMIT- _ 6A642 '- COUNTY OF LOS ANGELES. SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION BUILDING _ 9546• Lai Tunas Dr . JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY - NEAREST FOR APPLICANT TO FILL IN CROSS ST. . '-. 14 `EGA` Howard. Miller DESCRIPTION LOT NO. �© OWNER MAI` BLOCK TRACT ADDRE 431 Harvard Dr. , `j� � ADDRESS431 SIZE OF LOT NOWOON LOTS - CITYArcadia TEL. NO. 446-3377 USE IF DISTRICT NO. GROUP MAP I PROCESSED BY BUILDINGS BK PG CONTRACTOR Green Brothers J .Inc. a - F , ` ADDRESS 543 W. Woodbury Rd, 2 _ CONNECTION DATA - CITY Alt ad ena TEL. NO. 1798-8948 STATION DEPTH STATE 29515 CLASB C-21 MANHOLE REFERENCE UPPER LICENSE NO;. LOWER NO. F DESCRIPTION OF WORK FEE TY OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. d PUBLIC SEWER @ $5.00 - O P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. V PITS AND/OR DRAINFIELD @ 510.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE.DISPOSAL SYSTEM @ 53.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMEN RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER 53.00 _ W OVERFLOW SEEPAGE PIT.DRAINFIELD d EXTN..CESSPOOL.DRYWELL.MANHOLE'@ - - ' Tca ^��ABANDON HOUSE 55.00 HW Y.OR ST.WIDENING Z SEWER L SYST @ 53.00 STATE ENCROACHMENT PERMIT NO. - - INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S z o0 C -ECTION CHARGE FEE AUTHORIZATION rTOTAL,FEE dL+ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC S�WE . • --� DATE INSPECTOR'S SIGNATURE SIGNED THIS Ln� DAY OF April 197D - -• -I OWNER OR d' L.h-L�) % NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL S BUILDING OR WORK ADDRESSS W• W - SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 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 ❑ 1 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 I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RES IDE IN, THE BOVE DESCRIBED RESIDENTIAL PROPERTY. 7� ABANDON HOUSE SEWER SIGNATURE ACKFILL SEPTIC TANKS ❑ Y ]1 OF PERMITTEEL-a SEEP.PITS) ❑ CESSPOOLS- / 4 VALIDATIONACK R. ALLEN M:O. CASH SUPERVISING MECHANICAL ENGINEER. CK. ' 76A$42[f APPLI CATIo 06R PE m � �l COUNTY OF LOS ANGELES SEWS —SEWAGE CIISPOSA, " " ~DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 'BUILDING --, �/ 1 - JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 7717. 7 ,In C _ .�r J' Ar„, COLEMAN W. JENKINS..SUPT. OF BUILDING. 4 - - LOCALITY FOR APPLIC T TO FILL-IN z .NEAREST CROSS LEGAL DESCRIPTION LOT NO. ) OW, MAL _ BLOCK TRACT I •,ADDRESS, NO. OF BLDGS. ' SIZE OF LOT' t NOW ON LOT CITY, - TEL.*NO. - USE O BUILDINGS Y r DISTRICT NO. GROUP MAP PROCESSED BY BUI CONTRACTORO� L G3 / P ADORES IBJ CONNECTION.DATJX STATION DEPTH CITY L. NO. S LICI._ UPPER L IG EN SE NO: - -CLASS - ';i" MANHOLE REFERENCE / LOWE NO. D CRIPTION OF WORK FEE - _ TYPE'OF CONNECTIO LENGTH FROM HOUSE SEWER CONNECTING TO - Y.. CURB P-6fM.L.TO P.L. I PUBLIC SEWER 0 $5.00 SEPTIC TANK,-SEEPAGEPIT OR ,y� �'; P.C.NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP:NO. JOB NO. HOUSE SEW ER•CON NECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d PRIVATE DISPOSAL SYSTEM S3.00 Q CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -EASEMENT RECORD.INSTR..NO. DATE U WORK TO-HOUSE SEWER @ $3.00 C) OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.,CESSPOOL.DRYWELL.MANHOLE a ,$5.00, ' O ALTER.REPAIR OR ABANDON HOUSE - HWY. OR ST.WIDENING U SEWER OR DISPOSAL SYSTEM @ $3.00 - LU STATE ENCROACHMENT - CA- PERMIT PERMIT NO. - Z INDUSTRIAL WASTE APPROVAL P CHARGES OWNERS PERMIT s i 'O' CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE~ "" 1 HAVE AT THIS DATE A .CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE - TRACTOR TO-CONNECT THE ABOVE DESC .EXISTING DWELLING TO THE .PUBLIC SEWER. � APPROVAL DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY'OF 19_ OWNEROR NEW HOUSE SEWER OWNERS AGENT z: f CONNECT ADDITIONAL ( BUILDIN ADDRESS G OR WORK - I HEREBY ACKNOWLEDGE THAT'"I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) No STATE THAT THEABOVE IS'CORRECT AND AGREE TO COMPLY AND/"OR pRAINFIELD WITH ALL COUNTY ,ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SE"RSr2 CESSPOOL ❑ -DRYWELL".❑ I HEREBY CERT17,F/Y THAT 1 AM.PROPERLfREGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REf ED.BY LOS BANGLES OUNTY AND STATE OF 'SEWAGE DISPOSAL SYSTEM CALIFORNIA OR 'S' T I AM THE LEG/L O NER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, TH OVE DESCRIBED ,.ESI ENTIAL PROPERTY. - � ABANDON HOUSE SEWER - ' SIGNATURE ; -�fl// OF PeRMITTEE ? ` BACKFILL SEPTIC TANKS ❑• ' SEEP..,PITTF(S) ❑ CESSPOOLS ❑ / 7/7. VALIDATION JACK R'.•ALLEN p� SUPERVISING MECHANICAL'ENGINEER CK. M.0, CASH ;^