HomeMy Public PortalAbout10118 LA ROSA DR_Sewer__ T'A'Ar°
ceeoe B='ea APPLICATION"FOR PERMIT 7
COUNTY OF LOS ANGELESj
DEPAMIENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING A
ADDRESS
JOHN A. LAMBIE. CounlF En aer
CASSATT D. GRIFFIN, Supt e1 Building LOCALITY e
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL ^/
DESCRIPTION LOT NO. r OWNER
BLOCK e'— TRACT 0$'L.� MAIL
ADDRESS
NO.OF BLDGS.
SLE
ZE OF LOT NOW ON T CITY TEL. NO.
US
BUILDINGS ED DISTRICT N0.I GROUP MAP PROCEASED BY
J
CONTRACTOR L O PG i
ADDRESSA14 110
VT CONS/NEf,CT ON DATA
CITY TEL.N0. _ TION _DEPTH Q y
ATE MANHOLE REFEREry-
REGISTRATION NO. COUNTY (/�Q
NO. 1 DESCRIPTION OF WORK PtE 11i —.'•
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 3 TYPE OF CONNECTION LENGTH FROMSEPTIC TANK, �r
PITS AND/OR DRAINFGELDIT OR @ $3.00 T. CURB P.L. M.L.TO P.L. L
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXT N.. CESSPOOL. DRYWE LL $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ SI.00 CO.IMP.NO.IJOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ SI.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT f 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE " REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS�y OF 19_ NEWHOGSE
CON �n�(3'k ,✓,f Q/:A�_.
OWNER OR — (� /.�•^•�/ CONNECTA NAL `
OWNERS AGENT � BUILDING ORRADDITIONAL WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THA 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRE Y LOS ANGEIII�S COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM TXE LEGAL OWNER/OF THE ABOVE
DESCRIBED RESIDEN ROPERTY. '///_L7 BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP.PIT(S) ESSPOOLS ❑
OF PERMITTEE
®` VALIDATION ROBERT A. WOOD
CK. M.o, ustl SUPERVISING MECHANICAL ENGINEER
� '^ - -
J
APPLICA ION FOR PERMIT
ceeov a ev COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL.
BUILDING AND SAFETY DIVISION
BU
ILDING -
ADDRESS � F
CLtOHN A. LAMIE, cvu°!F En vv:
SATT D. GRIFFIN, Sup"t eI H�diw LOCALITY
NEAREST
FOR APPLICANT TO FILL IN moss ST.
LEGAL OWNER
DESCRIPTION LOT N0.
MAIL
BLOCK. TRACT ADDRESS
NO.OF BLDG$.
ME OF
l07 0 ON LOT CITY TEL N0.
USE OE DISTRICT Npp, GROUP MAP PROCES D BY
BUILDINGS ,.( IK PG
CONTRAC
oe
ADDRESS CONNECTION DATA
MA I
CITY TEL.NO. S TION , DEPTH
STATE MANHOL REFERENCE a-� _ PPER
REGISTRATION NO. COUNTY y� s
NO. I DESCRIPTION OF WORK FEE — P
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
PITS AND/OR�RAINRELDIT OR @ S3.00 Y. CUR P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT. DR A INFIELD If AJ
FXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNKPERMITNO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ S1.00
SEWER OR OpIPOSgABANDON L SYSTEM HOUSE @ $1 0 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OVMER'S PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION I 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 INSPECTORS SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT A�[.�y� BUILDING OR WORK
ADDRESS SEPTIC TA N K,S EE P.PIT(5)
AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL Cl
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY TH I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIR Y LOS ANGE ES LO.—
D STATE OF ABANDON HOUSE SEWER
CALIFORNIA ES TH AM THE L THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDE 1 OPERTY. SEEP. PIT(S) ❑ CESSPOO ❑
SIGNATURE
OF PERMITTE
o, VALIDATION ROBERT A. WOOD
CK, M.°, usa SUPERVISING MECHANICAL ENGINEER
I r.Y'..7 7 u rd OCT 1 "=. "i 5 .0