HomeMy Public PortalAbout9667 LAS TUNAS DR_Sewer__ 6AB42D
a•sa APPLICATION FOR PERMIT
><aaa
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS '
JOHN A. LAMBIE, County Engineer y x
'CASSAI t D. GRIFFIN, Supt of Building I LOCALITY =_ G
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOTND. -"0' OWNER �'_.�•
BLOCK TRACT ✓ MAIL,; ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT a CITY TEL, NO.
USE OF
BUILDINGS � �-: - - DISTRICT NO. GROUP - -MAP - PROCESSED BY
BK PG
CONTRACTOR`J.4
ADDRESS.� "z-�". ...-;.>g ".,' , CONNECTION DATA
CITY`r te ror ' .TEL.NO. �, A STATION f, <_ DEPTH
d [�- STATE 'MANHOLE�REFERENCE v � • UPPER~
REGISTRATION N0. ,,� "_ ❑ COUNTY y r" j, ,. ..: -n" 773OYrER
NO. DESCRIPTION OF WORK FEE --
HOUSE SE WER CONNECTING TO
,. P IBLIC SEWER cw $3,.00 TYPE OF CONNECTIONLENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB . ` M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3,00
OVERFLOW SEEPAGE PIT, DRAINNELD
EXTN„CESSPOOL,DRYWELL @ $2,00 -
HOUSE SEWER CONNECTING TO _ P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. No. �` -' _ JOB NOa
WORK'TO HOUSE SEWER
CONNECT ADDITIONA!.BLDG,OR 'TRUNK PERMIT N0. ROAD PERMIT'NO. -
R @ $1.00
ALTER.REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.01 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
-- OWNER'S PERMIT 2O1 0 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE w P°"s Imo.,. REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE I4EREIN NAMED CON-
TRACTOR TO CONNECT THE A$QVE DESCRIBED EXISTING DWELLING APPROVALS i DATY I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER, '" - --- -r
SIGNED THIS�DAY 4_., 19- NEW HOUSE SEWERw__. _
OWNER OR <.�.t CONNECT ADDITIONAL
OWNERS AGENT /. 3UILDING OR WORK
ADDRESS. SEPTIC TANK,SEEP,PITS)
- _AND,/OR DRAMPIELD
I HEREAY ACKNOWLEDGE THAT I HAVE READ 'THIS APPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. ALTER,REPADISPIR,
SYSTEM
OR.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE
N£CT'PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DI ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTIAL.PROPERTY. 13ACKFILL SF.PTIC TANKS ❑
SIGNATURE aP �- 9' g'`Y'I - _ SEEP.PITS) ❑ CESSPOQ LS ❑
OF PERMITTEE__, `'. .�...sr
�. '-VALIDATION ROBERT A. WOOD
cx. w o, CASH SUPERVISING. MECHANICAL ENGINEER
E L