HomeMy Public PortalAbout10126 LA ROSA DR_Sewer__ 14650-INSERTS r
CEBO08-60
>fiA842D APPLICATION FOR PERMIT.,
- COUNTY OF LOS ANGELES SEWER-SEWAGE, .DISPOSAL
DEPARTMENT-OF COUNTY ENGINEER - - -
BUILDING AND SAFETY DIVISION 'Buuo1NG
ADDRESS O Z :
ICHN A. LAMBIE. CDunly$n I$e�er. :C
g
WILLIAM.A. ]ENBEN, _oL:Huilding 'LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cftoss ST. it
LEGAL -� -
DESCRIPTION LOT NO. OWNER
BLOCK /i_ TRACT 'MAIL
ADDRESS - '-
C NO.OF BLDGS.
SIZE OF LOT NOW ON LOT J CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP' - BK MAPPROCESS BY
CONTRACTOR a- �(�_ K T I �) 41 /
HHH
a 4� ((L//�✓✓✓
ADDRESS CONNECTION 15ATA
CITY esTEL.NO. D 1, ;STATION / DEPTH
STATEMANHOLE REFERENCE
REGISTRATION NO. A ]/� ® COUNTY
NO. DESCRIPTION F WORK FEE -
HOUSE SEWER CONNECTING TO /�
PUBLIC SEWER @ $3.00 V V TYPE OF ION LENGTH FROM
PITS AND/OR DRAENFIELDSEPTIC TANK.SEPAGE T OR @ $3.00 CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TOL P.C-N0.
PRIVATE DISPOSASYSTEM @ SI.00 CO.IMP. N0. JOB N0. w
CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT N0. ROAD PERMIT N0. U
WORK TO HOUSE SEWER @ 31.00
SEWER OR UISPOSpL SYSTEM HOUSE @ SI 00 STATE ENCROACHMENT
'PERMIT N0. O
INDUSTRIAL4
WASTE APPROVAL W
CHARGES m
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE V v REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. _
TRACTOR TO 'CONNECT THE ABOVE DESCRIBED EXISTINGDWELLING- _ --'-APPROVALS - DATE-- INSP_ECTOR'SSIGNATURE
TO THE PUBLIC SEWE . y
SIGNED THIS - D tY OF -- - - NEW HOUSE SEWER
OWNER OR 'CONNECT ADDITIONAL
OWNERS AGENT _ _ - BUILDING OR WORK - -
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY.ACKNO EDGE THAT.., I.HAA,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
PLUMBING AND SEWERS. - _ . -: SEWAGE
DISPOSAL
ISPO ALSYS E ,.. .
I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR SEWAGE ECTPLUG'AND EM
LICENSED AS RED
UI RED BY OS ANGELES OUNTY AND_STATE OF,. DISCONNECT HOUSE-SEWER
HOUSES EWER--
CALIFORNIA OR THAT M THE LEGAL- ft OF T ABOVE BACKFILL LL SEPTIC TANKS O /
DESCRIBED RESIDENT PERTY_
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS �tl�H'7 iFLCR/1/WY��
- '"`'
OFPERMITTE
.ROBERT A WOOD.
_ - CK. M O, �usH/- SUPERVISING MECHANICAL ENGINEER
f_ 7 ; OCT 1 j 1 C1 0 5 .(.10jjj