HomeMy Public PortalAbout9569 LAS TUNAS DR_Sewer__ D
S&E-689 11-SS APPLICATION FOR PERMIT 1
6 8 E•8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles ADDRESS BUILDING GZ4
JOHN A LAMBIE, COUNTY ENGINEER yi`'�'�
I:J CASSATT D GRIFFIN, Sua'T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN C'O sT. &&ale
LEGAL
DESCRIPTION LOT NO ,� OWNER
MAIL -7-75— )f' _Q_?
BLOCK TRACT ADDRESS � �C.•Q_
A9 A
SIZE OF LOT NO.OW ON LOTS CITY Qy�! TEL NO 1'�3�v
USE OF r L
DISTRICT N0. GROUP MAP
BUILDINGS � � .e -_K /PG
CONTRACTOR .-� .,L
ADDRESS
CONNECTION DATA
� Z
CITY TEL. NO ,�' ] STATION Qi -DEPTH
MANHOLE REFERENCE j07
PPE
STATE
J� � 7� �I STATE R
REGISTRATION NO. ^!may C0 ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM
Y. CURB 4,F L M.L TO P.L
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD / P C. N0.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP. NO. Z57Z C, 10B NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED coN- APPROVALS DATE INSPEC 9R SI ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC_2EWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENTTr SEPTIC TANK,SEEP,PIT(S)
ADDRESS L 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
IICHEREBY CERTIFY THAT I AM PROPERLY REGIST D AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNT ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LE OW OF THE A OVE
DESCRIBED RESIDENTI PROPERTY. BACKFILL SEPTIC TANKS 11
GNATURE
SEEP PIT(S) ❑ CESSPOOLS !�
F
OF PERMITT ''C
JOHN A. LAMBIE, CQI§<Ty ENGINEER ALIDATION ROBERT A WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH
' W- 3878- OCT29 4 4..54 M
L