HomeMy Public PortalAbout10034 LA ROSA DR_Sewer__ DEPATLTBLENT OF COUNTY ENI GINF.ER SEWER—SEWAGE DISPOSAL _
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION - -- JL
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYNEAREST
—
ADDRESS lOQ LEl RnAB I?r. CROSS ST. -I%�lD-�L�`�`^' •`�� v
LOCALITY 111 A City \ DISTRICT,NO. SERIAL NO. gPERMIT N0.
NEAREST ems \ 5- . - /"-h!]/�q / / (� S
ei
CROSS ST. -B 1 ACPin Ave RyE�CEyI�V�ED BV Reedy Iar In3peetion DAfE ISSUED
OWNER V T PuAAAll J'li
ADDRESSI�Q�7A La Ro Sa Ih USE ZONE OC/CUS,A,N,C,Y OK MAP pa
CITY..... T Amp3* C4t3t TEL.NO.. BO. 07211 / I�J 'T
CONTRACTOR GenrgA KnollenbeTg CO.IMP.NO.
ADDRESS 652P N Bolden Went Ave JOB.NO.
CITY �BIIl1D5 TEL.NO.. At, 67212 TRUNK PERMIT NO.
$•STATE /
REGISTRATION NO. ]IQ.0B74 py��. ❑r'COTU TE ROAD PERMIT NO.
LEGAL
DESCRWTION LOT NO.BAlso E lCw N Of Lot STATE ENCROACHMENT
iF PERMIT NO.
BLOCK B TRACT 10821 INDUSTRIAL
p nL (i+ WASTE APPROVAL
SIZE OF LOT1'18_ Z86 NOW ON LOTSCHARGES
USE 0BUI DINGS DWA11 J= - / CONNECTION CHARGE FEE
NO. DESCRIPTION 0 WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER A 3 3.50 RECEIPT NO. I DATE �\ BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED)
WORK TO HOUSE SEWER 1.00 ! 00 NO.
ALTER OR REPAIR EXISTING DATES IBV
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH__
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNER$. S I 00
Y. CURB P.L. M.L.TO P.L.
PERMIT
AUTHORIZATION TOTAL FEE 2- 160
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER ,� /
SIGNED THIS._�_..__DAY OF.EBI7.�.._._._..Oa NEW HOUSE SEWER
OWNER OR �j� /A� BUILDING OR WORK OWNERS AGENW.....`.....�....Uil �
SEPTIC TANK,SEEP.PIT(S)
ADDRESS_............._......_......_.._....__..__._.._.._.-...._--_...-.___.._.-_- AND/OR DRAINFI ELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL C]
.CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS .ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT' I AM PROPERLY REGISTERED .DISCONNECT PLUG AND
—AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM/THE LEGAL OWN- ABANDON HOUSE SEWER
-ER-OF THE A_BOVE,{9�SCRIBED ftESIDE SIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE .-9 SE EP.PI T(S)Q CESSPOOLS
OF P E RMI TTE2222"''.4Sooddl�... ��'l ......_._._.._. K
7GA642A 603 7/53 1) -�,