HomeMy Public PortalAbout10220 LA ROSA DR_Sewer__ 546 INSERTS -
CE808 8.60
]8A844102D APPLICATION FOR PERMIT _
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION nDDRESSG 10220 La Rosa Dr, `
TORN A. LAMBIE. County Enggi...r
WILLIAM A. IENSEN. SMP'1 of Building LOC ALT" Temple City -
NEAREST Arden"Dr.
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL. OWNER a Corte.
DESCRIPTION LOT N0. ,J
BLOCK TRACT 7� EMAIL ADDRESS 10220 La Roda Dr.
NO.OF SLOG
SIZE OF LOT NOW ON LOTS CITY Temple CitV TEL. NO.
USE
-BUILDINGS DISTRICT NO. GROUP MAP OCESSED BY
.}�.
CONTRACTOR Joseph Cadilli Plb .Co. VQ r_ I BK PG' c�ct
ADDRESS 7821 E. Garvey Ave. CONNECTION-DATA
,TyS. an Gabriel TEL.NO.AT-05349 STATION DEPTH
134935C36 STATE MANHOLE REFERE7CE UPPER
REGISTRATION N0. COUNTY LOWER
NO, I DESCRIPTION OF WORK FEE ` _
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CC IN CTION LENGTH FROM
PEPTIC TANK.TS AND/OR DRAE NFII ELDPAGE IT OR @ S3.00 Y. CURB P.L. M.L.TOP.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
L.
EXTN..CESSPOODRYWELL @ SZ.00
HO SE SEWER CONNECTING TO P.C.N0.
ATE DISPOSAL SYSTEM SI.00 CO.IMP.NO. JOB NO. „
CONK TO HOUSE SEWER NECT ADDITIONAL BLDG.OR
WORTRUNK.PERMIT NO. R PERMIT NO. O
@�.i.
V
SEWER OR UAISPOSAL SYSTEM HOUSE @5100 STATE ENCROACHMENT
.PERMIT NO. O
'INDUSTRIAL II++
WASTE APPROV W
CHARGES N
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION 100 REIMBURSEMENT FEE
IHAVE NMED CON.
TRACTORp TO CIONNECT THE ABOVE DESCRIBED EXIISTDATE A CONTRACT WITH THE IINGADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF-19—
NEW HOUSE SEWER I Al
OWNER ORA CONNECTA OR
/y� `! •�'
OWNERS AGENT BUILDICONNECT
WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR pI S0 GE ECT PLUG AND
LICENSED AS REQUIRE BY LOS ANGELES COUNTY AND.STATE OF ABANDON HOUSEBA D '
CALIFORNIA OR THAT AM THE LEGAL OW iCR�QF THE ABO BACKFILL SEPTIC TANKS �.
DESCRIBED RESIDEN A PROPERTY. C BEEP.PIT(S) ❑ CESSPOOLS
SIGNATURE �1 y / S
OF PERMITTE - - -
®" VALIDATION ROBERT A. WOOD
CR M.°. CASH SUPERVISING MECHANICAL ENGINEER'
`LF1,O0.,7 6.3is 9 1 O D
3.00 K