HomeMy Public PortalAbout9645 LAS TUNAS DR_Sewer__ 'E808 10
6A6420 -63 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL jh
BUILDING AND SAFETY DIVISION aIJ 1 LIDI NG
3 ""
ADDRESS
1A
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup't of Building
LOCAL FN
NEA R E ST
_R.ES ST
FOR APPLICANT TO FILL IN CROSS-
LEGAL NER
LOT NO. ow
MAIL
BLOCK I R A C T ADDRESS
NO. OF SLOGS.
SIZE OF LCT t N OW ON LOT CITY r ki, TEL. NO.
USE OF
DV�TRICT NO. 4 0 MAP 5 E.,D
S BY
UPI 8K PRCCE0
PG
CONTRACTOR
4-
ADDRESS CONNECTION DATA
STATION
DEPTH
CITY TEL, l'i
--------- D-PPER
REGISTRATION NO, STATE MANHOLE REFERENCE
-.Cc.-j T'
NO. DESCRIPTION 09 WORK FEE TYPE OF CONNECTION LENGTH FROM—.---_--..--
:
DONNE - T6M.L.TO P.L.
CTI
H SOS SEWER E NG Y. CURB P.L.P L.
PUBLIC SEWER @ $5.00 1.
SEEPAGE PIT OR PC.NO
c��N
PITS AND/OR DRAIN`Flrl_Ll C 0.1 M,P. N 0, JOB NO,
c7r c_
HOUSES W R CONINECTINIa TO
TRUNK PIERSIftNO, ROAD PERMIT NO.
LPRfVATE.DISPOSAL.SYSTEM @ $3.00 1
CIONNILCTAPDITIONAL BLDG�OR A—FPI;�AVIT [W-AMER F,_FAS_E� R.NO DATE
WORK TO h'OuSE SEWER @ 53.00
OVERFLOW'EFPAGE PIT,DRAIN FIE,LO j Q
___7tEXTN C,ESSPOOL,DRY WELL.MA N HOLE Q-D S500
HVVY. OR ST.WIDENING
@ 2�3 Do
SENOR FM
STATE ENCROACHMENT
PERMIT NO,
!NDQSTRIAL
WASTE APPROVAL
4
CHARGES
OWNER'S PERMIT
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ---------------
I HAVE AT THIS DATE A CONTRACT' WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR To CONNECT THE ABOVE DESCRiDED EXISTING DWELLING
TO THE PUBL;C, SEWER, APPROVALS DATE I INSPECTORS SIGNATURE
SIGNED 'THIS DAY OF-1--
OWNER OR NEW HOUSE SEWER
OWNERS
WN ERSAGrNr77_7—,. rONNFCT ADO.TIONAL
BUILDING OR WORK
ADDRESS 4_
SEPTIC TANK.SEEP,P:T(!S)
IHERESY ACKNOWLEDGE THAT I KVE READ THIS APPLICATION AND,/OR ORA:NF)E,JD i
AND SHTCOMPLY _
WITI?
TATE THAT THE ABOVE IS CORRECT AND AGREE O COMPALL, C-0 U NTY ORDINANCES AND STATE LAWS REGULATING
PL'UMB F LL
iNG AND SEW RS, CESSPOOL 0 DRYWE
F PROPERLY REGISTERED AND/OR -A
I HEREBY CERTIFY THAT I AM ALTER REPAIR.SEWER OR
IC ENSv 0 AS REOUIRED BY LOS ANGLES COUNTY AND STATE Or SEWAGE WSPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL%OWNER OF, AND INTEND TO
'_iIt_isC&iNrCT PLUG AND
RcSfHOUSE
DE .4 T ABANDON
if HE A SOVE, SCRs BED RESIDENTIA' PROPERTY.
BACKF-ILL.SEPTIC TANKS
OF PERMiTTEE
SEEP,PIT(S) r! CESSPOOLSQ
. ,_VALIDATION ROBERT A. WOOD
CK. W O. CASH SUPERVISING 1,1ECHA-LAICAL ENGINEER
JUL