HomeMy Public PortalAbout10156 LA ROSA DR_Sewer__ TEMPLE CITY
CESOS-8 APPLICATION FOR PERMIT 1�
caeoe-B-so COUNTY OF LOS ANGELES .
SEWER_ =SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION ADDRESSG --10156 La Rosa .
IOHN A. LAMBIE. County Engineer -
CASSATr D. GRIFFIN, SuP t e1 Building' LOCALITY Tempie City -
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEADESCRIPTION LOT NO. - OWNER John Rl. Fitzgerald
BLOCK TRACT NO.OF SLOGS. OV.. MAIL ' 2112la1 'Resa Rica Road
ADDRESS
SIZE OF LOT NOW-ON LOT CITY TEL. NO.
USE OF
BUILDINGS Res • DISTRICT NO.1 GROUP I MAP P OCESSED BY
CONTRACTOR •• • OnS ruC ton BK PG
.S
ADDRESS 5136 North Bleecker CONNECTION DATA
clTyBaldwin Park TEL.NO. ED 8-3024 STATION DEPTH Q
STATE MANHOLES F ENCE 1 �! P
REGISTRATION NO. COUNTY k ' - 'LOWER
NO. I DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO
PUBLIC SEWER G $3.00 TYPE OF CONNECTION -' LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR y, - CURB. P.L. L.TO P.L.
PITS AND/OR DRAINFIELD @-$3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q S2.GOHOUSE SEWER
PRIVATE DISPOSAL SYSTEM CONNECTING TO $j,00 CO.IMP.NO. oZ/ JOB NO. a4�
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER $I.00 S TRUNK PERMIT N0. ROAD PERMIT NO.
@
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISP SAL STEM 57.00 PERMIT NO.L
INDUSTRIAL +
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENYFEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS TE INSPE �OR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR NEW CONNECT ADDITIONAL ,
OWNERS AGENT BUILDING OR WORK -
SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE.THAT I 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 I AM PROPERLY REGISTERED AND/OR ECT PLUG AND
ONN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND'STATE OF DISCONNECT
ON HOUSE SEWER -
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESID PRQP6RTY. ^ BACKFILL SEPTIC.TANKS ❑
EP. PIT 3 CESSPOOLS
SIGNATURE
OF PERMITTE t 5�
h1
®. /-'{�YIMM MIX
ROBERT WOOD /
. ca, e.g. . SUPERVISING MECHANICAL ENGINEER
LIT03 5 0 6 i-u It . 7 1 1 D 2 5 .0 0
2�6so9roiT��—
DEBOD ' COUNTY OF AP
PLECATI IV FOs E RETUT E:AGE .DISPOSAL,. 1'
>snsazD
LOS
DEPARTMENT*OF COUNTY-ENGINEER'- -
BUILDING AND SAFETY DMSION BUILDINGLAM
gq ADDRESS
NvTyN{li IENHSENIE. C Sup't of ildin9 LOCALITY -
INEAREST - -
FOR APPLICANT TO FIT N CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACY EMAIL
If ADDRE S
NO.OF BLDGS. -'
SIZE OF LOT NOW ON LOT CITY - TEL. NO. . 7�1.
USE - DISTRICT N0. �P OCESSED BY
BUILDINGS ` I GROU �K MAPpo �
CONTRACTOR
ADDRESS r CONNECTION DATA -
CITY TEL. 0. STATION + DEPTH Q
STATE MANHOLE WERENCE C UPPER
REGISTRATION N0. ❑ COUNTY 4 LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $3.00TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. 1
PITS AND/OR DRAI NFI ELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CES SPOOL.DRYWELL @ $
2.00 ^
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $I.00 'C0. IMP. NO. JOB N0. Y
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT,NO. O
WORK TO HOUSE SEWER (@ $1.00 O
SEW EF OF DISPOSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT
PERMIT NO. p
INDUSTRIAL V
WASTE APPROVAL W
CHARGES m
OWNER'S PERMIT g 2 DO CONNECTION CHARGE FEE a
A=ORIZATIONJ TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS 0 TE INSPE TOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS � DAY O�F 19_ NEW HOUSE 1� Q I°�. I L..�.
OWNER OR � r.� CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT,PLU G AND
LICENSED AS REOU I RED BY LOS ANGELES.COUNTY AND STATE OF. ABANDON HOUSE SEWER' -- - - - - "
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES ROPERTY SEEP.FPIT( PCESSP0
S) 000❑S ❑
SIGNATURE '�
'OF PERMITTE
®" LIDATION ROBERT A. WOOD. -
CX. M.o.. GSH. . - SUPERVISING MECHANICAL ENGINEER
LACo 5 5 0 5 t•JAR .7 1 0 o _ 5.0 0,