HomeMy Public PortalAbout9635 LAS TUNAS DR_Sewer__ 'E808 55
'6A642,'-65 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING I!-
1011N A. 1kMlll[, CountyFnginor ADDRESS_
COIYMAN V JENKINS, Sup't. of Building LOCALITY
NEAREST ew�l
FOR APPLICANT TO FILL IN CROSS ST.
RIGPTION
LOT NO .-N..
L-,9141V
111-42�3 MAIL
BLOCK TRACT ADDRESS
IN 0 OF BLDGS.
SIZE OF LOT NOW ON LOT CITY 'TEL. NO.
USE OF
I
DISTRICT NO..,GRO 1�-p MAP PG PROCESSED-0 BY
BUILDINGS- SK
v
CONTRACTOR
n
ADDRESS CONNECTION 40
STATION DEPTH
U N 1 7-
CITe TEL NO.
LICENSE
NO. I-AS 53 MANHOLE REFERENCE
LOWER
NO. DE$CRI PTlON OF WORK EE PE OF CONNECTr LENGTH IF
j7- B P
-&-us IT - CUR --�l
EWER CONNECTING TO L M.L.TO P.L.
I PUBLIC EWER o�5 I— -
$ 5.0 1
P.C.NO.
SEPI-Ift fANK,-SFEPAGE 112-
JOB NO,
OR DRAINFIELD $1 0. CO.IMP.NO. /��75
PITS AND 00i 0
--7- u
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRI
VATE DISPOSAL SYSTEM $ 3.00�
-OAT NT
CONNECT ADDIT 1 ONAL SL DG, OR AFFIDAVIT W RECORD-INSTR.NO DATE
WORK TO HU IT SEWER' $ 3.001 0
SEWER
OR DISPOSAL SYSTEM $ 3.001
LLI
-p FT-,-,71T N1 ttLU HWY.OR ST.WIDENING C.
EXTN.,CESSPOOL, MANHC,'-E $ 5.00:
-t--------- . . ... I STATE ENCROACHMENT z
PERCOLATION TEST $ 5.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT 2 00
AUTHORIZATION -Toi� E CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCR ED EXISTING DWELLING
TO THE PUBLIC APPROVALS DATE SPECTOWILYSIfINATURE
SIGNED THIS =R6 IN
DAY 0
OWNER ORN NEW HOUSE SEWER, A9
OWNERS AGENT-- CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
I HEREBY ACKNOWLEDGE THAT I HAVE REAL) THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
AND
STATE THAT THE
E ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL [-I DRYWELL ❑
IHEREBY 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
A OR THAT I AM THE LE INNER OF, AND INTEND TO
W INT, DISCONNECT PLUG AND
'URE.,�E
RESIDE E IN, THE SCRIBED
ABANDON HOUSE SEWER
SIGNATURE BAC
OF PERMITTEZ% q BACKFILL SEPT IC TANKS
SEEP.PIT(S) 0 CESSPOOLS
'--VALIDATION
M.O. CASH
LIV;O 2 jUL 2 1 1 0 D 0