HomeMy Public PortalAbout9608, 9610, 9610 1/2 LAS TUNAS DR_Sewer__ CE808 2/70 d �
76A 642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER AooRE55
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
NEAREST
O APPLICANT TO FILL IN CROSS ST.
(PRINT OR TYPE ONLY)
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RGPTION LOT NO. L7 OWNER titJ I✓�1
/' MAIL 70-7
BLOCK TRACT �'•�(Y ADDRESS,L' �jp'o 0
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO.1 GROUP CLASS MAP PROCESSED BY
I BK PS
CONTRACTO ^.! SC.J�.�`'f� \�/I D PL'"
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ADDRESS /7 �£ NN
COECTION DATA
CI7Y
rrL"TEL. NO.r ✓ STATION 3 DEPTH
STATE � LIC G, MANHOLE REFERENCE / UPPER
LICENSE NO. t/" CLASS (.r-
NO. DES RIPTION OF WORK FEE TYPE OF CONNECTIO LENGTHCO. IMP.NO.
P.C.NO.
OM /�✓/
HOUSE SEWER CONNECTING TO .� �,zj Y. CURB P.L. M.L.TO .L. �I
PUBLIC SEWER -f71?60 - Z )
SEPTIC (ANK.SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD � E10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. >_
PRIVATE DISPOSAL SYSTEM QD 53.00 D_
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT w�1YE[ [AS[M[NT RECORD. INSTR.NO. DATE O
WORK 70 HOUSE SEWER @ $3.00 U
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE Q $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Q
SEWER OR DISPOSAL SYSTEM @ f3.00 STATE ENCROACHMENT U
PERMIT NO. W
CL
INDUSTRIAL V)
WASTE APPROVAL Z
OWNERS PERMIT s _ Oo CHARGES
AUTHORIZATION TOTAL FEE 0__, CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF )9_
OWNER OR NEW HOUSE SEWER �J
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 ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSEDAS REOUIR J OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA I HE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A -SCCRRRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
/ I
SIGNATURE BACKFILL SEPTIC TANKS ❑ J
OF PERM"TC - ---- SEEP.PIT(S) ❑ CESSPOOLS ❑-/� y.b
VALIDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
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M.0 CASH
Lt�tC7 DrG 9100 107 .00-