HomeMy Public PortalAbout10153 LA ROSA DR_Sewer__ 76A84ZOAPPLICATIOWFOR PERMIT 1
5&'E-663 11-55
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County.of Loa Angeles 'OIL""RESS /S 3 ,iyL
JOHN A. LAMBIE. COUNTY ENGINEER
m CASSATT D. GRIFFIN.-SUP'T OF BUILDING - L—OC—ALITY
FOR APPL>I•CANT T FILL LEGAL ��I/N 1 c"IA ss T
DE
SCFOR
LOT N0. (�' �(/ �3-",,.�j,A�/'Z OWNER ,
BLOCK TRACT �� p Z /•� MAIL
ADDRESS '
NO. OF BLDGS. CIIA TEL. NO.
SIZE.OF LOT NOW ON LOT
USE OF
BUILDINGS % ]STRICT N0. GROUP MAP
-.
.CONTRALTO EJ� •= Z� �G
CONNECTION DATA
ADDRESS
..� STATION I �1 5 DEPTH '
CITY i T No.: MANHOLE REFERENCE f'� EsI �rIL UPPER
1 1 .CAT LOWER
REGIS RATION N0. ❑.COUNTY
NO. DESCRIPTION QFFAOR9 FEE
TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO y- CURB P.L. M.L- TO P.L. (/J
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR - -
PITS AND/OR DRAINFIELD @ $3.00 1 '
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. 3 Z I P. C. N0. -
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $ 2.00 .JOB NO.
HOUSE SEWER CONNECTING TO )
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.-/ �J�Y
CONNECT ADDITIONAL SLOG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO. - - -
.ALTER:REPAIR OR ABANDON HOUSE INDUSTRIAL 1. -
'SEWERORDISPOSALSYSTEM @ $1.00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE -
OWNER'S pEIMUT s 1 00 -
AUTHORIZATION TOTAL FEE
REIMBURSEMENT.FEE
1 HAVE AT THfS,DATE A CONTRACT WITH T E' EREJN N MED CDN- APPPROROVALS DATE INSPECTOR'S SIGN ATURE
TRACTOR TO CONKImQ ABOVE DESCRIBED EXISTING DWELLING ' �%+
TO THE PUBLIC.SEWE _ HOUSE SEWER -� y 1 eLL
..r , .
SIGNED THIS AY OF tY-A�- CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK
OWNERS AGENT `• SEPTICTANK,SEEP;PIT(SI
ADDRESS- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGESH T 1 HAVE R A THIS APPLICATION CESSPOOL ElDRYWELL❑
AND STATE THAT THE ABOVE 5 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 1 AM PROPERLY REGISTERED AND/OR SCONNECT PLUG AND
LICENSED-AS -REQUIRED BY LOS ANGELES COUNTY AND STATE OF A ANDON HOUSE SEWER
r
CALIFORNIA- qR THAT I f1M. TH EGAL OW OF T OV
D SCRJSED RF�ygE gOPER CKF ILL SEPTIC TANKSCESSPOOLS
LS
R/1_M"_1R_ �P ACKFILPIT(S)PTI CESSPOOLS —27b
PERMITTE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION--\ ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. Y.0. CUPSX _ l -
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8 8 7N OCT31 4 4.5'0 �_