HomeMy Public PortalAbout10017 LA ROSA DR_Sewer_5/2/1956_house sewer to public sewer APPLICATION. FOR PERMIT
e&EfieHIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depostmedt of County Engineer
County of Los. Angeles BUI LD�NG
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESSf.�..J'
® CASSATT D. GRIFFIN, SUPT OF BUILOII,ic LOCALITY
s - - .a
FOR APPLICANT TO FILL IN CROSS ST. y
LEGAL OWNER _
DESCRIPTION 'LOT NO f�0
Qq� MAIL
BLOCK TRACT wy GV ADDRESS
N0.IIF BLT CIT TEL. NO.
512E OF LOT NOW ON LOT '
USE OF DISTRICT NO. GROUP MAP
BUILDINGS �/''
PG
CONTRACTOR 'P t_ M l_2 � L � fiC�
ADDRESS t� r� ' 10 �Mr„r /y ,6, ` CONNECTION DATA
STATION `J 2 0 7 DEPTH A 6
CITY d TEL. N0.
MANHOLE REFERENC _ UPPER
J ❑ STATE
REGISTRATION NO. -� 4 � / ❑ COUNTY 1.
No. . DESCRIPTION OF WORK FEE
PE OF CONNECTION LEN H FROM N O
HOUSE SEWER CONNECTING TO w, Y. CURB P.L. M.L.TO P.L. .J
PUBLICSEWER @ $3.50 7
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD @ $3.00OVER / S y
EXTNF CESSPOOL,RYW ELL,MAN LOW SEEPAGE PIT, HO LE @ $2.00 CO. IMP. NO. / y K� JOB N0�
HOUSE SEWER CONNECTING TO y
PRIVATE DISPOSAL SYSTEM @ 51.00 TRUNK PERMIT NO. ROAD PERMIT NO./40 cp
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ 51.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM @ $L00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 1 p0^0
AUTHORIZATION TOTAL FEE
7 0 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER _
SIGNED THIS AY OF 19 CONNECT ADDITIONAL
OWNER OR �� ///./¢,.y p— BUILDING OR WORK
OWNERS AGENT )Q "( «c- lam` SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR GRAINFIELD -
'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYW ELL❑
AND STATE THAT THE ABOVE 15 CORRECT AND .AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE .LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED A5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I Ar THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIALy PERTY. BACKFILL SEPTIC TANKS❑ ,
SIGNATURE
SEEP. PIT(S) [I-CESSPOOLS
OF PERMITTEE '
JOHN A. LAMBIE. CO NTY ENGINEER ' ----IqILIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR `
SCK/ Y.O, CASH
L, 0 5 b 4' 8 .MM ?. 4 4.50 In