HomeMy Public PortalAbout10133 LA ROSA DR_Sewer__ - D
5&E66
APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
r Department of County Engineer
County of Los Angeles. DUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ( (rfjl t /•��Jn.
® CASSATTD. GRIFFIN, SUPT OF BUILDING - LOCALITY if-<�9�-r%sc�Cai �iLk-1
FOR APPLICANT TO FILL IN eROSRs ST. /
LEGAL /Z fj !'✓ !N 7 (P� OWNER
DESCRIPTION LOT N0. /
/Qy.G/ MAIL
BLOCK / TRACT .G ADDRESS
SIZE OF LOT(nly 9 7d NOW ON LOTS CITY TEL. NO.
USE OF
DI "y4:'J / J� DISTRICT NO. GROUP MAP
BUILDINGS i2C'DC. y �i�
CONTRACTOR_ �CAi �" _ .1 1
BK PG`!
.i L"' S CONNECTION DATA
ADDRESSo > , -
CITY STATION -25DEPTN -
�y .p MANHOLE REFERENCE
/ �.�!l �ll COUNTY
REGISTRATION N0.(iTY
G,
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ��--yy Y TYPE OF CURB TION P.L. MEL GT FROM
PUBLIC SEWER @ 11 350 (/O
SEPTIC TANK.SEEPAGE PIT OR
I PITS AND/OR DRAINFIELD @ $3.00 —
OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. N0.
E%TN.,CESSPOOL,DRYWELL,MANHOLE @ b E.00 CO. IMP. NO. / ; 10B N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT N0,
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 00
AUTHORIZATION TOTAL FEE � REIMBURSEMENT FEE
f � '
1 HAVE AT THIS DATE A CONTRA WITH THE HEREIN NAMED CON-
APPROVALS DATE INSPECTORSSIGNATURE
HAVE
TO CONNECT THE ABOVE
OESCRIBEp EXISTING DWELLING
TO THE PUBLIC SEW _ NEW HOUSE SEWER ( m
i y
f n
SIGNED THIS DAY OF G ii 0�t /,eene 19 CONNECT ADDITIONAL
OWNER. OR
-1 � BUILDING K,WORK -
OWNERS AGENT -Q Z SEPTIC TANK,SEEP, PIT(S)
ADDRESS _AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL EJDRYWELL[IAND STATE THATTHE_ABOVE 15-CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL.SYSTEM.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES AND STATE OF. ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE..LEGAL. OWNER OF THE ABOVE. _
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS O I r v
SIGNATURE rSEEP. PIT(S) ❑CESSPOOLS �L �tL
OF PERMITTE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CKI �,0_ CASX -
l to s (S._6 1T, OCT 10 10 A 5.0 0 m
` TEMPLE CITY
CEBDB 3APPLICATION FOR PERMIT {�
]fiA692D u
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. CountyEngineer ADDRESS Rosa Dr.
WILLIAM A. JENSEN. Supt of Building Temple Cit
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `NDS$ ST. iclaman
_ `EG"` IN-� 5 �t / Z Manual Moderno
DESCRIPTION LOT NO. OWNER
MAIL ^
BLOCK TRACT /�� MAILADDRESS l 133 La Rosa Dr.
NO. OF BLDG5. /�
SIZE OF LOT NOW ON LOT 2 CIT ( itTEL. NO,
USE OF
BUILDINGS Rea. & Gar• DISTRICT NO. GROUP MAP PROCESSED BY
�/ BK PG /
CONTRACTOR SQuare Deal Sp�W_or LS'eryice -/'�� �� 1 J L
ADDRESS 2933 Maxson Rd. CONNECTION DATA
I )_ r ni O STATION DEPTH
UPPER
CITY ]TEL. NO. I* /y V/❑�
STATE
X28870 ❑ COUNTY OWER
REGISTRATION NO. MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIONTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L T
PUBLIC SEWER 55.00 P.C.NO. O
SEPTIC TANK.SEEPAGE PIT OR
PITS gNe/OR DRAINFIELD � SI0.00
CO.IMP.NO. JOB NO. (�
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
HOU ATEDISPOSAL EWERCONNECTIN @ 53.00 (()
_RRII
CONNECT ADO I TIONAL BLDG.OR 00 AFFIDAVIT WAI En SEM[ RECORD, INSTR_NO. DATE
1 WORK TO HOUSE SEWER @ 33.00 3
OVERFLOW SEEPAGE PIT.DRAINF HE
LO
EXTN„CESSPOOL.DRYWELL.MANH O LE B $S.00 r/J
ALTER.REPAIR OR ABANDON HOUSE
HWY. OR ST.WIDENING Z
SEWER OR DISPOSAL SYSTEM cb f3.00 STATE ENCR04CHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPR
_ CHARGES
OWNERS PERMIT sl 21 00 il
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
1HAVE 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 J .-j
OWNERS AGENT CONNECT ADDITIONAL
OGRESS BUILDING OR WORK
SEPTIC TANK.ANK.SEEP.IELD (5) V
1 HEREBY THAT
THE ABO THAT 1 HAVE REND THIS APPLICATION AND/OR DRAINFIELD
WITHSTATE THAT THE ABOVE IS CORRECT TE AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLV MBING AND SEWERS. CESSPOOL ❑ DRYW ELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/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 AND NTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESC IBED RESIDENTIAL RO RTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMTfTEE_ SEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
cK.
M.0. CASH SUPERVISING MECHANICAL ENGINEER
L:iLO2 4 4 8 1VRc5 1 0 D 5.00-