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Home My Public Portal About10037 LA ROSA DR_Sewer__ / , 6AB42 0.63 APPLICATION FOR PERMIT CE 08 1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, County Engineer WILLIAM A. IENSEN. Bup't of Building CA OLITY NEAREST FOR APPLICANT TO FILL IN CROSS S, EGAL DESCRIPTION LOT NO. OWNER A MAIL �) BLOCK TRACT/ �_ ADDRESS — / ` jko- ) ` NO. OF/LOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF o�. DISTRICT NO. GROUP MAP P CESBED BY BUILDINGS !tel BK PG CONTRACTOR /�✓�� t�r n R �i ADDRESS, � ��// / q Q ,JJJ CONNECTION DATA CITY /,J /N// TEL. NO.�r "(�(J� CFR�,� / ) ATION DEPTH REGISTRATION NO. S l-2i_0 l `�/ LJ COUNTATETY MANHOLE REFERENC [�[ //� LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CON N LENGTH FROM HOUSE SEWER CONNECTING TO I Y. P.L. M.L.TO P.L. PUBLIC SEWER ® $5.00 � SEPTIC TANK.SEEPAGE PIT OR P.C. NO. _. O PITS AND/OR ORAINFIELO @ 510.00 CO.IMP.NO. JOB NO. / v NOVSE SEWER CONNECTING TO TRUNK PERMIT NO' ROAD PERMIT N PRIVATE DISPOSAL SYSTEM 53.00 J O /1 CONN E CT ADDITIONAL BLDG.OR I AFFIDAVIT WAIVIq AaMV0 Uxr RECORD. I NSTR.NO. DATE WORKTO HOUSE SEWE R ® S3.00 V OVERFLOW SEEPAGE PIT.GRAINFIELD W E%TN_CESSPOOL,DRYWELL.MA N HOLE® S5 .00 � d ALTER,REPAIR OR ABANDON HOUSE HWY.O W D SEWER OR DISPOSAL SYSTEM ® 53.00 STATE M T x PERMIT NO. (J INDUSTRIAL ��II � //JJ � � O WASTE APPR0?1(JU'U4LW. OWNERS I PERMIT s 21 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CON RIUCT WITH THE HEREIN N MEO CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE B VE DESCRIBED EKISTI GA DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS AY.O OWNER OR ( NEW HOUSE SEWER �'IZ� OWNERS AGENV_X CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION AND/OR DRAINFMLD ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DPYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISP05AL SYSTEM CALIFORNIA OR THAT I AM THE AL OWNER , AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DE BED REST ENTI PROPERTY. ABANDON HOUSE SEWER SIGNATURE OFREEE BACKFILL SEPTIC TANKS ElOF PE _ _ SEEP,PIT ISI ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CN. M.0. CASH L1o5637�— NOV 5 10 0 7.00" s CE60310-63 APPLICATION FOR PERMIT ]6A542D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS Q 7 7 ��p WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAR EARE^vT V—/f FOR APPLICANT TO FILL IN CROSS ST. .GAL DESCRIPTION LOT NO. OWNER j�/ �� / M41L ./ L� f �N BLOCK TRACT ADORES$ NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED.BY BUILOIN OS �P E, /B'K PG .,/ CONTRACTOR r�/^�O'L� O-_'(_� ��/ 1 �j H /�/{Z ApDREss CONNNPECTION DATA ll f�{//�/ �' �$� CITY /S pN�C TEL. NOeq�— C-2 X19 J— ATION '/, DEPTH -M IS (, ❑ STATE MANHOLE REFEREN E REGISTRATION NO. �� ` Y �� J ❑ COUNTY w'! LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CON LENGTH FROM H OUSE SEW Efl CONNECTING TO V. �� P,L, M.L.TO P.L. 3.S PUBLIC SEWER SS,00 JL>^^Le d SEPTIC TANK,SEEPAGE PIT OR P.C.NO, O PITS AND/OR GRAINFIELD @ SIO.00 CO.IMP.NO. JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMITN Q[ PRIVATE DISPOSAL SYSTEM 53.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT nneq EASEMENT RECORD,INSTR.NO. DATE r WORK TO HOUSE SEWER ® S3.00 v OVERFLOW SEEPAGE PIT,DRAINJFI IJP W� EXT N..CESSPOOL.ORYWELE.M Y OLE® S5.00 ALTER.REPAIR OR ABAN N E HWY.O W ERIN ' SEWER OR OSAL S _ 53.00 STATE ENCROp H ENT L j PERMIT NO. /' INDUST RIAL WASTE APPROVAL CHARGES OWNERS PERMIT s� wll--sem AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER I'IZ'6 OWNERS AGENT CONNECTID DURESS OR W BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS ATION AND/OR GRAINFIELD AND TO STATE THAT THE ABOVE IS CORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REE GULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESC D RESIDER IAL P PERTY. ABANDON HOUSE SEWER $IG NATURE OF PERMITT BACKFILL SEPTIC TANKS ❑ ❑ SEEP,PIT(S) ❑ CESSPOOLS LIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH Lr1W 5 6 383-' NOV 5 11 D 2 5.0 0"