HomeMy Public PortalAbout10116 LA ROSA DR_Sewer__ 7 '
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CEBDB B.BP APPL CATION FO .PERMIT 1-
COUNTY OF LOS ANGELES SEWER-SEWAGE. DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AIIRETS' O
CASSATl'AD.GRIFFIN,°sua t ui�aainv - - '
LOCALITY
S
NEARET
FOR APPIdCANT TO FILL IN La, ST.
LEGAL N/
DESCRIPTION LOT NO. / OWNER
BLOCK G TRACT I0 /y MAIL
ADDRESS
N0.OF BLDfS.
SIZE OF LOT NOW 0 LOP CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROC SED BY
CONTRACTO
ADDRESS — IiCi J j / � CON/NECTION DATA
CITY TEL.N0. ION DEPTH /
3 ATE MANHOLE REFER NCE,/
REGISTRATION N0. COUNTY /j.r, J _/��;-
NO. DESCRIPTION OF WORK FEE fP
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAE P
PITS AND/OR DRAINFGELDIT OR @ S3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTM..CESSPOOL.DRYWELL @ S2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER C@..$1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR OISPOSAL SYSTEM @ $1.00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERSPERMIT $ Z 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE O-O REIMBURSEMENT FEE
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT WITH THE IINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. //
SIGNED THIS DAY 19_ NEW HOUSE SEWER �/193�t 'wyj"+2
OWNER OR ��� CONNECT ADDITIONAL
OWNERS AGENT IBUI LDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL [IWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIR BY LOS ANGEL COUNTY AND SETATE OF ABANDON HOUSE SEWER
CALIFORNIA THA M THE LEG HER
OF THABOVE
DESCRIBED RESIDE PERTY. {/' BACKFILL SEPTIC
❑D CES POOLS
SIGNATURE (.`
OF PERMITTE
®' VALIDATION ROBERT A. WOOD
CK II.G. C.AStl SUPERVISING MECHANICAL ENGINEER
7 . 7 OCT j p 5
J�
E8En
C580eoe 809 APP ICATION FOh PERMIT -
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY D VISION ADDRESSG D
CASSATTORNAD. GRIFFIN. SuP� of BuildingI NEAREST
•• - _
LOCA LITT '/`
OR APPLICANT/TO FILL IN
CROSS ST.
LEGAL / OWNER
DESCRIPTION LOT NO.
BLOCK TRACT Q 2 MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
LDINGS DISTRICT NO. GROUP MAP PROCE D BY
BUIG
k5LCONTRA SK .
ADDRESS CONNECTION DATA
CITY S TEL.NO. Q T TION DEPTH
TAT MANHOLE REFfiRENCfi- PP
REGISTRATION NO. COUNTY v!,,RW . "~
NO. 1 DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK.SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM (�
PITS AND/OR DRAINFIELD @ S3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ 52.00
HOUSE SEWER CONNECTING TO CO. IMP. N0P.C.NO.
PRIVATE JOB N0.
PRIVATE DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. ,
WORK TO HOUSE SEWER @SI.00
A LTE R.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
EWER OR DISPOSAL SYSTEM $1.00 PERMIT NO.
axt-ol-d Is] INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT g �L� CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE O—D 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 --PAJyeOF 19_ NEW HOUSE SEWER
OWNER OR e /�Jy CONNECT ADDITIONAL
OWNERS AGENT /(c'�v� BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP. PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALT ER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL'SYSTEM
I HEREBY CERTIFY THAT AM PROPE Y REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOU[RED B LOS ANGELES COUNTY ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT THELEGAL WN THE ABOVE
DESCRIBED RESIDENT] Y. BACKFILL SEPTIC TANKS E
SIGNATURE " SEEP.PITS Cl CESSPOOLS ❑
OF PERMITTEE
®" VALIDATION ROBERT A. WOOD
CK. Y.u. /dGS/B/ SUPERVISING MECHANICAL ENGINEER
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