HomeMy Public PortalAbout10148 LA ROSA DR_Sewer__ DEYAICTIU= OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY . ' PE:5MIT�;MeLICATION
COUNTYANGELES " BUILDING
7-y/ % _ 0�✓�,��
WILLIAM J. FOX.
Cc COUNTY ENGINEER �I ADDRESS-
FOR APPLICANTJO FILL-IN LOCALITY
BUILDING y����" �� NEAREST
All KESS CROSS ST.
LOCALITY DISTRIO. A SERIAL N0. '� PERMIT c
NEAREST
CROSS ST. RECEIVED BBYY,, Ready for Inspection /DAATE/ISSUED(�J
OWNER U /.a Q�N>/691, fV i/U� —S/�
MAIL USE ZONE OCCUPANCY MAP_
ADDRESS
A BK PG
ACITY TEL.NO. A- — I
CONTRACTOR
CO.IMP.N0. �-
ADDRESS/!7 JOB NO. _
CITY TELAO. TRUNK PERMIT NO.STATE
,
REGISTRATION NO.
® COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. y�n/'y� ,ry STATE ENCROACHMENT
rC, � PERMIT NO.
BLOCK TRACT '/D INDUSTRIAL \
WASTE APPROVAL
_ / �J
SIZE OF LOT x26✓ NOW ON LOTS CHARGES l
USE OF
BUILDINGS CONNECTION CHARGE FEE /
NO. DESCRIPTION OF WORK FEE I
REIMBURSEMENT FEE
H OUSE SEWER CONNECTING TO
NO USE SEWER CONNECTING TO PUBLIC SEWER � 6 3.50 —�/ RECEIPT NO: I DATE\ BY
PRIVATE DISPOSAL SYSTEM 1.00 J
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO- DATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION 414. 5 DEPTH
CESSPOOL—DRYWELL A1q -
SPECIALCONDITIONSONLY 2.00 �- J NUPPER REFERENCE ♦nWrn
TYPE OF CONNEOTION LENGTH FROM
OWNERS PERMIT f I Il QD *- CURB 1/ et M.L.TO P.L. lI
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING ,APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.......A.....DAY OF._ ww--y_r/ ;----------IgSy NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
,7/ y 4 I /
OWNERS A EN ...U:d._...�.....:..:!A^'I------ '�'� _ BUILDING OR WORK
ADDRESS... ..... AND/OR GRAINFIELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Q DRYWELL 0.
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 'I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR-LICENSED ASREQUIREDBY LOS ANGELES COUNTY ABANDON HOUSESEWER.
AND STATE OF CALIFORNIA OR THAT I AM THE1�LEGAV OWN-
ER OF THE ABOVE DBACKFILL SEPTIC TANKSEl
SIGNATURE SIB RESWENTIAL PROPERTY.��/{/�j� /j/�/, SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE__...... __ i
.� 76A642A 663 7/53 O OPT