HomeMy Public PortalAbout9630 LAS TUNAS DR_Sewer__ 7
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APPLICATION FOR PERMIT
A 6 642DD
6;A
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. of BUILDING f
LOCALITY 'S
NEAREST -��
FOR APPLICANT PE O FILL IN ST.CR065 S .
ONLY:
DESCRIPTION LOT NO OWNER
MAIL
BLOCK fRAC'T *: ! ADDRESS
NO. OF BLDGS.
512E OF LOT NOW ON LOT CITY TEL. NO.
USE 0F_-_ .—__
BUILDINGS DISTRICT tiO. GROUP CLASS MAP PRO,ESSED�BY
CONTRACTOR � i /J 8-- 'L.•l 1I i
sK I
4
ADDRESS .[� "\7 „ (/J� CONNECTION DATA
'. DEPTH
CITY _ TEL NO. STATION �`f_ ry�f J Z._ e'3
STATE / ,r•} LIC MANHOLE REFERENCE
LICENSE NO, / 3 1 CLASS ,..' x
NO. ❑ESCR! TION OF WORT{ FEE � ..
OWER
_ _ _ TYPE OF CON NEC7tSTAF" � LENGTH FR r
HOUSE SEWER CONNECTING TO^ ] f- Y CURB P,L,lM L.TO P.L.
PUBLIC SEWER
-PT" NK D
SEEPAGE PIT R !` J P C NO.
l PI75 ANDFA AOR DRAIN FIELD $10.00 -
CO.IMP. NO,P �� .108 NO.
ROUSE SF VER CONNE TING TO TRUNK PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTEM @ $3
00_ __
-CONNECT ADDITIONAL BLDG.OR - - AFFIDAVIT wAfVER.I EA5EMFRt RECORD,IN5TR.NO. DATE - -
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT 7 DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MANHOLE@ $5:,00 HW V. QRST WIDENING
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $3.DO _ _ - - ----------- -'---- ---
---- - --- -.-- ---- -}- .--.-- STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
-_.___.. _._. �.___. CHARGES
OWNER$ PERMIT s oo
AUTHORIZATION1 TOTAL FEE Ir
c^ CONNECTION CHARGE FEE -1---' �^ --
I HAVE 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 I INSPECTOR'S SIGNATURE
SIGNED THIS {� DAY OF 19� �
WNER OR NEW EW HOUSE SEWER
r �•
N ERS AGENYW_. .'. -
���' CONfV£CT ADDITIONAL
BUILDING OR WORK I
DRESS'— -=-f'�
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK-SEEP,PIT(S)
A ND:/OF'DRA:NFIELD {
STATE THAT THE ABOVE IS CGRRECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ING AND SEWERS. CE55POOL ❑ DRYWELL
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAI R,SEWER OR
D AS REQUIRED BY L.OS ANGLES COUNTY AND STATEOF SEWAGE DISPOSAL SYSTEM
.NIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND �7 —
IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
RE
MTTTEEBA KFILL SEPTIC TANKS E3
SEE'.w ISI Q CESSPOOLS ITII
VALIDATION-- 4 1 JACK R. ALLEN
° OUP£RVISING MECHANICAL ENGINEER
CK. M.O. /CASH