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Home My Public Portal About10115 LA ROSA DR_Sewer__ 3eaAI20 ,,.,, APPLICATION FOR PERMIT 1 DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL _.., Doartment of County-Engineer County of Los Angeles BUILDING .JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS / QL'.IPS A /L•O SA CASSATT DGRIFF_IN',:5 .P OF Buaowc.. LOCALITY 7"t ` FOR-.'APPLICANT TO FILL IN, cnoss LEGAL - OWNER :._.: .! Y• .. DESCRIPTION LOT-NO (1 L BLOCK. .TRACT G MAIL OO Z I ADDRESS NO. OF BLDGS CITY TEL. NO. - - SIZE OF LOT NOW ON LOT USE OF -. BUILDINGS F - DISTRICT NO. .GROUP MAP I BK PG-_ CONTRACTOR /_ 'X fill ['O� t N o 1 CONNECTION DATA ` ADDRESS "Z-Z W !'qti� /l a / -STATION Q DEPTH CITY ^to, a TEL. NO; � �- Q� .MANH14�I-STATE OLE REFERENCE D I _ REGISTRATION NO. COUNTY OWE ,No DESCRIPTION OF WORK FEE - - HOUSESEWEBCONNECTINGTO / TYPE OF CONNECTIO LENGTH FROM PUBLIC SEWER" @: $ 3.50 J Y. CURB P. M.L.TO P.L. SEPTIC TANK,SEEPAGE,PIT OR PITS AND/OR DRAINFIELD © $3.00 - OVERFLOW SEEPAGE PIT.DRAINFIELDP'C. NO.. EXTN.,CESSPOOL;DRYW ELL,M AN HOLE Q $2.00 •G" p0"Nn° HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $11.00 TRUNK PERMIT NO, ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 ':.PERMIT NO. -.,ALTER REPAIR OR ABANDON HOUSE - - INDUSTRIAL " 3EW ER OR'DISPOSAL;SYSTEM �j "$"1'.00 _WASTE APPROVAL. . _ CHARGES �' --- ---- "-; "CONNECTION CHARGE:FEE'. - OWNER'S PERMIT - -b 1 oo _ - - AUTHORIZATION TOTAL FEE REIMBURSEM ENT'FEE Sa 1 HAVE'AT,`THIS DATE A CONTRACT WITH THE HEREINAPPROVALS-CON -- APPROVALS' DATE IN,SPECTOR'S SIGNATURE ,TRACTOR-TO CONNECT. THE ABOVE DESCRIBED EXISTING DWELLING' TO THEPUBLIC-SEWER. , -.. .- . - . • NEW HOUSE SEWER - ^ SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL - OWNER .OR' i" BUILDING,OR WORK - •OWNERS AGENT I_ e � - -+ SEPTIC TANK,SEEP,PIT(S) - -ADDRESS- AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT I HAVE.READ THIS APPLICATION, - r - AND„STATE jHAT. THE„ABO,VE IS;_CORRECT.AND AGREE.TO'..COMPLY- FESSPOOL❑ DR YWELLLl - WITN �ALL�,EOUNTY. ORDI_NANCEB SAND: STATE LAWS REGULATING- ALTER,REPAIR,SEWER OR' 'ePLUM9I NG AND.SEWERS `. - - _ - ---' _$EWAG E DISPOSAL SYSTEM I-HEREBY- CERTIFY'-4HAT-I"AM 'PROPERLY REGISTERED, AND/OR DISCONNECT PLUG AND - �LICENSED A3 REQUIRED eY LOS:ANGELES {O,UNTY AND-'STATC OT ARANO ON.HOUSE SEWER CA L IFORNIA•_OR THAT 1 THE LEGAL ER OF THE..ABOVE'� - - - DESCRIBED RES,I OENTIAL PERTY - - c BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT($) 0 CESSPOOLS w .OF(PERMITT JOHN At LAMBIE tEo' TY'ENfsINEER -"e""P 'VALIDATION ROBERT'.A. WOOD;CHIEF PLBG_JB NsPcTOR .4 CK 31.yY,O .:CASH ._ lA 0.9 z' E,M .AUG 2 4 4-5::0 _,1D :_ .