HomeMy Public PortalAbout10134 LA ROSA DR_Sewer__ 0
CEaGS.a-ae APPLICATION. FOR PERMIT - 1
eaoe. COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
SEWER—SE,WoOAGE- DISPOSAL
BUILDING AND SAFETY DIVISION ppDRESSG Qf r G.' >•✓
JOAN A. LAMBIE, County Engineer.
CASSATP D. GRTPFIN, Supt of Building
NEAREST ,
FOR APPLICANT TO FILL IN crtoss sT. /
LEGAL ; OWNER
DESCRIPTION- LOT N0.
BLOCK TRACT f QMAIL
ADDRESS c
NO. OF BLDGS.
SIZE OF LOT I NOW ON LOT CITY TEL. NO.
USE OF L :L_
BUILDINGS �' DISTRICT NO. GROUP MAP PRpCESSED BY
CONTRACTOR
ADDRESS 0e, CC(•iLA"� - CONNECT N DATA
CITY IZ.J �% TEL, NO. d-(. LJZ�7 STATION - DEPTH
STATE UPPER
REGISTRATION NO. �'157' � J y B COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC 7 NK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y- CURB P.L. M.L. TO P.
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 Co.]
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @.$1.00
ALTER,REPAIR OR ABANDON SEWER OR DISPOSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNE'R'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. 'APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF I9_ NEW HOUSE SEWER ,(
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ���d` BUILDING OR WORK �C
SEPTIC TANK,SEEP, PITS)
ADDRES
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
1 HEREBY CERTIFY THAT 1 AMPROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEG L OWNER OF THE ABOVE.
DESCRIBED RESIDENTIA ti ROPEXY. f j r{/ BACKFLL SEPTIC TANKS❑/L' BEEP. I LL, ❑ CESSPOOLS
SIGNATURE '7 �s
OF PERMITTEE.
®r VALIDATION ROBERTA.WOOD
CK. M.o. DASH SUPERVISING MECHANICAL ENGINEER
LAC08 4 2 7 J04241 -1 0 A 3.00 .