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Home My Public Portal About10142 LA ROSA DR_Sewer__ CE8408 t 1°-'27BAAPPLICATION FOR PERMIT E8 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer AGDREss WILLIAM A. JENSEN. Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FIL RpsS ST. GAL DESCRIPTION LOT NO. OWNER G I (� TRACT D�/ F/ MAL MAL BLOCK V NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO, USE OF BUILDINGS DISTRICT NO. GROUP MAP SK PGPROCESSED BY 9 CONTRACTOR �� GH� X ADDRESS `CONNECTION DATA CITY TEL. NO. ��J'� (�✓ ST ION a DEPT E�BTATE MANHOLE REFERENCE PPER REGISTRATION NO. ❑ COUNTY '7 NO. DESCRIPTION OF WORK fEE TYPE O CON C LENGTH FROM / HOUSE SEWER CONNECTING TO Y. M.L.TO P.L. PUBLIC SEWER $5.00 .�,,(( P_<. NO. SEPTIC TANK,SEEPAGE PIT OR ry_� JOB NO. PITS../OR DRAINFIELD $10.00 CO. IMP.NO. vv HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N PRIVATE DISPOSAL SYSTEM 33.00 CONNECT ADDITIO N AL BLDG.OR AFFIDAVIT .RYrx r... RECORD.INSTR.N . DATE WORK TO HOUSE SEWER 83.00 OVERFLOW SEEPAGE PIT,GRAINFIELD EXTN..CESSPOOL.DRIWELL.MAMHOLE@ 35,00 ALTER.REPAIR OR 0.SANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCS Oq CH MENT PERMIT N INDUS L WAST A OWNER$ PERMIT E z 00 CHARGES 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 O TE INSPECTO 'S SIG AT E SIGNED THIS DAY OF 19_ i- ✓�� OWNER OR NEW HOUSE SEWER S OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW.LL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/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 INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RE IDENTI L PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE_ SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. wood cK. M.D. CASH SUPERVISING MECHANICAL ENGINEER LI�I�0 8 2 4 C,;,o JJL J 1 1 0 D 7k) ll" 7GA64 ID-u2 APPLICATION FOR PERMIT CE 08 1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer ADD N. WILLIAM A. JENSEN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN R°SS ST_ LEGAL DESCRIPTION LOT NO. L OWNER �pla MAIL BLOCK/ TRACT B ADDRESS NO. O N LOGS. SIZE OF LOT NOW ON LOT CITY TEL, NO. USE OF BUILDINGS DISTRICTNO. GROUP MAP PROCESSED BY //BK PG CONTRACTOR H ADDRESS,. �� CONNECTION DAT 1 CIT TEL. N°. S ATION �t H DEPTH �— STATE LY Cl UPPER MANHOLE REFERENCE / 1�1� yJ. / REGISTRATION NO. COVNTY { { ABX" NO, DESCRIPTION OF WORK FEE TYPE OF CON E r LENGTH FROM HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P,L. PUBLIC SEWER f5.00 P.0 NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. �j PITS AND/OR DRAIN ETD �2 $10.00 C°. IMP. NO. C HOUSE SEWER CONNECTING TO TRUNK PERMIT NO.. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM ® $3,00 MY 5[MEM R CONNECT ADDITIONAL BLDG.OR AFFIDAVIT ECORD.INSTR.NO. GATE WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,OESSP°OL,DRYWELLMANH°LE® f5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING _ SEWE OR DISPOS LSYSTEM E3.00 STATENCR HMENT PERMITENO. INOUSTfl CHARGES ACHARGES �Y WASTE {� OWNER'S PERMtr s .q e�c/r� AUTHORIZATION I TOTAL FEE PL� CONNECTION CHARGE FEE I HAVE 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_ OWNEROR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR GRAINFIELD AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS, CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/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 INTEND TO DISCONNECT PLUG AND RESIDE IN. THE=BED BED RESIDENTIA PROPERTY. pBAN°ON HOUSE SEWER SIGNATURE M SACKS EPTIC TANKS PERM ❑ OF ITTEE SEEP,PIT 151 ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH L. ,,o 2 4 5a ;,t 31 1 1 D 2 5.C) 0.., i