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Home My Public Portal About10144 LA ROSA DR_Sewer__ , _I� ` AS42 62 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 EngineeE ADDRESS WILLIAM A. JENSEN. Sup't of Building t LITY ESTFOR APPLICANT TO FELL S ST. LEGpL ��DDESCRIPTION LOT NO. ) ER Q " MAIL BLOCK TRACT QaZ�/ ADDRESS NO, OF BLDGS. SIZE OF LOT NOW, ON LOT CITY TEL. NO, USE OF BUILDINGS DISTRICT NO, GROUPI MAP PROCESSED BY - CONTRACTOR , �l ADOREell1 V CONNECTION DATA 'ffC..��✓✓✓"�� CITY TEL, NO.I' / /p/jQ S39TI.N - DEPTH AA t STATE UPPER L� K/ COUNTY MANHOLE REFERENCE 1� Y � REGISTRATION NO. /1 NO. DESCRIPTION OF WORK FEE TYPEOF CONI C i LENGTH FROM d HOUSE SEWER CONNECTING TO Y. ��P.L. M.L.TO P.L. PUBLIC SEWER a $5.00 P.C.NO O SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR GRAINFIELD ® $10.00 CO.IMP.NO. _ JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT N _ PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 11Y SEM[X RECORD, INSTR,NO. DATE WORK TO HOUSE SEWE R ® $3.00 OVERFLOW SEEPAGE PIT,GRAINFIELD CAEN_CESSPOOL,DRYWELL,MANHOLE @ $5.00 Z ALTER.REPAIR OR ABANDON HOUSE HWY,OR ST. IDENING SEWER OR DISPOSAL SYSTEM ® $3.°O STATE C ACMME (1 M4� IIA � ' WASTE APPROVAL CHARGES OWNERS PERMIT $ z 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE TRACTOE R TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S!II']]G��N.pY�TJJU�RE SIGNED OWNER OR HIS DAV OF 19 NEW HOUSE SEWER by r/ j� ry X OWNERS AGENT CO..ECT ADDITIONA L H ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PITIS) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION pNp/OR GRAINFIELD AND STATE CTHATOUNTY THE'ABOVE IS CORRECT AND AGREE E COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑ 1HEREBY CERTIFY THAT 1 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 AB DESCRIBED ;FNT PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(5) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD M.0. CASH SUPERVISING MECHANICAL ENGINEER Lit,,0 8 2 4 6 10 aur 31 1 7.0 0- `A081(142D 62 TBAPPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE' DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING D JOHN A. LAMBIE. County Engineer ADDREs3 WILLIAM A. JENSEN. Sup't of Building LOCALITY / NEAREST FOR APPLIC��A{{--N�yyTT�TO LL I CROSS ST. LEGAL / (/V � DESCRIPTION LOT NO. '� OWNER MAIL -BLOCK TRACT - ADDRESS. NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL:. NO. USE OF DIBTfl ICT NO. GROUP MAP PPRO�ESSED BY BUILDINGS �/(� CONTRACTOR e ✓ � �K �P ADDRESS ' J - ,CONNECTION DATA CITY TEL. NO.�•f!' ST ION / DEPTH ) STATE MANHOLE REFERENCE UPPER REGISTRATION NO. C� COUNTY ICpwq� NO. DESCRIPTI N OF WORK FEE TYPE OF CONNECTI LENGTH FROM a'� HOU$E SEWER CONNECTING TO Y. CVq M.L.TO P.L c(- PVELICSEWER ® $5.00 P.C.NO SEPTIC TANK.BEEPAGE PIT OR . PITS AND�OR9RA INFIELD @ S10,00 CO.IMP.NO, JOB NO. Ayryy HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT / ^ PRIVATE DISPOSAL SYSTEM @ S3.00 'l CONNECT ADDITIONAL BLDG.OR AFFIDAVIT � *AIVIA I11111KIRECORD,INSTq,NO. DATE W ORK'TOHOUSE SEWER @ S3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD. E%TN..0 ESBPOOL.DRY WELL.MANHOLE $5.00 ALTER,REPAIR OR ABANDON HOUSE HWT.OR. .WIDENING SEWS OR DISPOSA_6 SYSTEM 83.00 r STATE£N ROgCHMENT PERMIT eFUA INDATRIAL - '••' WASTE APPROVAL OWCHARGESNER'S PERMIT s� .sus• ' AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE � 0'(J 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 5 SIGNATURE SIGNED THIS DAY OF 19_ - OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL _.. BUILDING OR WORK, ADDRESS SEPTIC TANK.SEEP,PIT(B) I 'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND.AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ ,HEREBY CERTIFY- THAT I AM PROPERLY REGISTERED AND/OR ALTER,.REPAIR,S EWER 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 OIBCONNECT PLUG AND RESIDE IN, THE ABOVE O ESCR BED RESIOENTIq PROPERTY. ABANDON HOUSE SEWER SIGNATURE DACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑' CESSPOOLS'❑ CC -,VALIDATION ROBERT A. WOOD M.o. cases SUPERVISING MECHANICAL,ENGINEER u1vD '3'2 4 7U JUL 1 1 1 D 2 5.00—