HomeMy Public PortalAbout10021 LA ROSA DR_Sewer__ • "- t ' ��' 24650,INSERTS ,
7ss«o`° APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE. DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER -- BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 1OOC' 'Lam'. OS
IOHN A: LAMHIE, Couvty,E.giveer { ;�
WILLIAM,A. JENSEN. Supt of Bvildioq LOCAL6 'V•�
NEAREST •.
FOR APPLIW TO FILL INCROSS ST ,
LEGAL SOW NER 'v
-0EHCRI PTION LOT N -
-BLOCK TRACT AADDDRDR
ESS .
NO.OF GLOBS,
SIZE OF LO NOVj ON LOT _ CITY .TEL. NO. .
USE OF DISTRICT NO. GROUP - MAP P111jjj000CESSEI Y '
BUILDINGS -5 V / I _ PG (/ J
CONTRACTOR ('IY_ -CI-1 *f, p
/
ADDRESS CONNECTION DATA b -
CITY 467 TEL.NO. ION DEPTH -
STATE :MANHOLE REFERENCE11 P
REGISTRATION NO. ❑ COUNTY Ll
NO. DESCRIPTION OF WORK .FEE
HOUSE SEWERCONNECTING TO
PUBLIC SEWER @ 83.00 TYPE OF CONNECTION LENGTH FROMSEPTIC 7�1
PITS AND/OR'SEEPAGE GRAINFIELDT OR @ $3.00 'Y. CURB P.L. M'.L.TO P.L. V Cl
OVERFLOW SEEPAGE PIT. GRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00 _
P.C.NO.
HOUSE E DISPOSAL NESTING TO -CO.IMP. NO. .JOB NO.
PRIVATE DISPOSAL SYSTEM @ 81.00 -
CONNECT ADDITIONAL BLDG.OR
WORK C HOUSE SEWER @ %1.00 / 57/'3)7
�TRUNK.PERMIT NO. ROAD PERMIT N0. °i
U
ALTER, REPAIR
OR 5 L ABANDON
HOUSE @ $I 00 'STATE ENCROACHMENT _
SEWER PERMIT N0. O
INDUSTRIAL ' N
- WASTE APPROVAL W
CHARGES - m
OWNER'S PERMIT § CONNECTION CHARGE,FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE /
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ __
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS ' DATE' INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS- -0AY OF 1D— NEW HOUSE SEWER --
OWNER OR �- CONNECT-ADDITIONAL
OWNERS AGENT- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT d HAVE READ THISAPPLICATION -- ---- -- - - +- --- -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ /1
WITH ALL COUNTY ORD CES AND STATE 'LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWE / SEWAGE DISPOSAL SYSTEM H
1 HEREBY CERTI THAT I AM PROPERLY REGISTERED AND/OR
DISCONNECT PLUG AND
LICENSED AS ]RED BY LOS ANGELES COUNTY AND STATE OF, ABANOOWHOUSE SEWER
CALIFORNIA 0 HAT I AM THE LEGA OWNER THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED R L PROPERTY. S P.PIT(S) ❑.CESSPOOLS El
«�
OF PERM] y� '
®L VALIDATION ROSERT A. WOOD
ort. N.0. (�usHGJ SUPERVISING MECHANICAL ENGINEER _,
• +;"'f '"."54650'INSERTS . . '
°6A642D °
'8A6420 APPLICATION FOR PERMIT. ,"
COUNTY OF LOS ANGELES SEWER—SEWAGE ;DISPOSAL•„ J.
DEPARTMENT OF COUNTY ENGINEER" _
BUILDING AND SAFETY DIVISION ADDRElSs•. BD.a C•. .4a Kos
IOHN A. LAMBIE. County Engg��sneerng ,LOCALITY
/yy
WILLIAM A. IENSEN. Supt eE HuHdi
MEARE
FOR APPLICANT TO FII.L IN
.CROSS 9T.
DES LEGAL LOTH {OWNER
AIL
BLOCK TRACT [ADDRESS.
NO.OF BLOCS. CITY TEL ND.
SIZE OF LOT NOW ON LOT
BUILDINGS BDISTRICT NO. GROUP MAP PROCESSED BY
BUI _ /I �BK ^` '
CONTRACTOR
ADDRESSZ - _ A CO2 CTION DATA
C,_
CITY ,_ TEL.NO. f �Y T N DEPTH,
VTATE
REGISTRATION NO.
�'�-T/ �1 COUNTY MANHOLE REFERENCE
NO:. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 7
PUBLIC SEWER @ $3'.00 TYPE OF CONNECTION LENGTH FROM �7
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. J
PIT$AND/OR DRAINFIELD @ S3.00 ,
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN., CESSPOOL.DRYWELL @' $2.00 P.C.NO.
HOUSEiEW ER LONNECTINGTU CO. IMP. N0. JOB NO.
PRIVATE 015POSALSYSTEM @ SL00. -
CONNECT ADDITIONAL BLDG.OR .TRUNK PERMIT NO. ROAD PERMIT NO. (� w
WORK TO HOUSE SEWER @SLOG _ J � ��Z V
ALTER.REPAIR OR AB ANDON HOUSE STATE ENCROACHMENT C.
SEWER OR OISPOSA LSYSTEM @ $1.00 PERMIT N0. O
INDUSTRIAL V
WASTE APPROVAL µt
CHARGES N
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE—
AUTHORIZATION TOTAL FEE &-L) REIMBURSEMENT FEE
TRACTOR TO CHAVE AT THIONNECT THE AB VEDATE AT EVRIWITH ED EXIISTIINGHE HEREINAME DWELLGNG APPROVALS (DCTE JINSPECTOR'3SIGNATURE
TO THE PUBLIC SEWER. ♦ -
SIGNED THISDAY OF 19 NEW HOUSE SEWER
OWNER OR . CONNECT ADDITIONAL
OWNERS-AGENTIrV _.BUILDING OR WORK. _
ADDRESS , SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS-APPLICATION- - -- - - - •- --- --.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL O DRYWELL.❑ 5' ''• t' '
WITH ALL COUNTY ANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING ANO S. -
I
' HEREBY FY T T I AM PROPERLY REGISTERED AND/OR -SEWAGE DISPOSAL SYSTEM
LICENSED A R OUIRE BY i05 ANGELE -COUNT ANO STATE OF. .DISCONNECT PLUG AND _
CALIFORNI 0 TH 1 AM THE -L 0 E OF THE .ABOVE ABANDON HOUSE SEWER` - - -
DESCRIBED RE D L PROPERTY. SEPTI
SE P..PIT(SI,
TANKS.CESSPO
SIGNATURE
OF PEPMITTE
®r VALMATIONV 1\ ROBERT A. WOOD
R M.O. CASH ) SUPERVISING MECHANICAL ENGINEER -_
16 8 r_<. G.{J:\r �^� .N: _ .� _• _ _ _