HomeMy Public PortalAbout9600-9602-9604 LAS TUNAS DR_Sewer__ 76A6 420
E• APPLICATION FOR PERMIT 1
8 8 §89 11.55
'DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING /.�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS C/ v
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CAS
SATT D. GRIFFIN, SUPT OF BUILDING LOCALITY -1wv
FOR APPLICANT_ TO FILL IN CROSS sr.
LEGAL
LOT N / OWNER
DESCRIPTION 0.
5 / MAIL
J
BLOCK TRACT ADDRESS
NO.OF BLDGS.
SIZE OF LOLta� /G NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS K DISTRICT NO. GROUP MAP PIS
l�
CONTRACTOR
, I/ CONNECTION DATA
ADDRESS v
.• STATION a DEPTH
CITY �Y TEL. N0, 0 �� `� MANHOLE REFERENCE UPPER
[:1STATE e
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEEg�`-�- ry�rI ALI
HOUSE SEWER CONNECTING TOTPE OF CONNECTIO LENGTH FROM
PUBLIC SEWER @ $3.50
Y. CURB P.L M.L.TO P.L. /
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. NO, 3 O fp JOB N O
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERM ROAD PER N0. _
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 CH GE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE (? REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING `
TO THE PUBLIC SEVER. NEW HOUSE SEWER
SIGNED THIS DAY OF �� 19 CONNECT ADDITIONAL
OWNER OR "'�'j'/ •'/Ci / BUILDING K,WORK
OWNERS AGENT��/� =�[/r/""'��/ SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY 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 THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPER f r/ „ 0 BACKFILL SEPTIC TANKS❑
SIGNATURE Y .,/jL`•, -f�j��C_; SEEP.PIT(S) [I CESSPOOLS Z4
OF PERMITTEE ) (�r^ r• VT'^
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PI RG. INSPECTOR
CKK CASH
1 5 0 2 czar 19 . 4 45- 0