HomeMy Public PortalAbout10225 LA ROSA DR_Sewer__ =a^E°g 3APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer -
County of Los Angeles AUDRE59 dd`�+`<•f Q S
JOHN A. LAMBIE. COUNTY ENGINEER
® CASSATT D. GRIFFIN. SUPT OF SU ILOING LOCALITY G
I
LEG
FOR APPLICANT TO 'FILL IN cRoss ST. —
DE CRAPTION LOT NO. OWNER
��y MAIL
BLOCK TRACT �./� ADDRESSNO OF BLD
� I G r//
SIZE OF LOT pA$ JY O NOW ON LOTS TWV CITY C, TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GR P MAP -
CONTRACTOR BK PPG
�
ADDRESS OrS 5 lq�OS S CONNECTION DATA
CITY// A G_ TEL. NO. /,��6f�� STATION DEPTH ^
V MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO. ❑ COUNTY ,
NO. DESCRIPTION OF WORK FEE / '� ",Q
/b
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM .
_ .PUBLIC SEWER @ $3.50 Y CURB P:L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
EKTN.,CESSPOOL,DRYWELL,M A NHOLE @ $2.00 CO. IMP. NO. _ 10B NO. _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 U V PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s o0
AUTHORIZATION, TOTAL FEE REIMBURSEMENT,FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. /r/ � NEW HOUSE SEWER
SIGNED THIS -' AY F 4I_4r do19�{L CONNECT ADDITIONAL
OWNER _ OR BUILDING OR WORK
OWNERS AGENT
SEPTIC TANK.SEEP,PIT(S)
ADDRESS Zl�..S..S �'� S Y AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
ANO STATE THAT THE ABOVE IS 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' I AM PROPERLY REGISTERED AND/OR ECT PLUG AND
ONN
DISC
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISZ ON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPEj. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PITS) ❑ CESSPOOLS El
OF PERMITTEE wi '
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIOU,, ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH A -
i`j' �0 4 2 6S !L7 61 -0 A 3.0.0
DEPARTATENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES /LDINO //
WILLIAM U. FOX, COUNTY ENGINEER I pUI KESS �0�2 6`2A, (ld-,-)�'
FOR APPLICANT TO FILL IN LOCALITY
y 'ADDREISS O S--S- �j �o/ �p 6 r/ NEAREST
CROSS ST...
LOCALITY �.yT 12//6 Gvrl DISTRI'C`T N0. SERIAL NO. PERMIT NO. C
NEAREST /, / - 'A' ��j S
CROSS ST. {{/- Q/t/y / /._
/. /� /�R3�E,CCEIVED BY Ready lar Inspection �DATEISSUE,D�
OWNER ,D910 / /To G NA'3 V.J[/L117� Tr
MAIL USEZONE OCCUPANCY MAP
ADDRESS IO J.�.� LO/r/. SP /1 I BK 'PG
CITY�'71 fJ/Q TEL.NO. O-DLI!' ' /�7
CONTRACTOR,
CO.IMP.N0.
ADDRESS
JOB.N0.
!
CITY TEL.NO. TRUNK PERMIT N0.
.
❑ STATE 4
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL ./ STATE ENCROACHMENT' - ✓
DESCRIPTION LOT N0. f'/ PERMIT N0. !
BLOCK TRACT 3 S� ' INDUSTRIAL'
WASTE APPROVAL
SIZE OF LOTN
O OF BLOCS.
NDW ON LOT CHARGES
USE ?
BUILDIDI NGS CONNECTION CHARGE FEE
NO. I DESC IPTION OF WORK FEE REIMBURSEM ENT'FEE _\
HOUSE SEWER CONNECTING TO
PUBLICSEWER X ® $ 3.50 RECEIPT NO. I ATE BY HOUSE SEWER CONNECTING TO'
PRIVATE DISPOSAL SYSTEM IAO
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 I
ALTER OR REPAIR EXISTING NO' l
I /DATE \1-BY
- SEWER OR DISPOSAL SYSTEM 1.00
AND/OR DISPOSAL SYSTEMN SEWER 1,00 CONNECTION DATA
SEPTIC TANK.SEEPAG E PIT OR
PITS AND/OR DRAINF I EL 2.00 STATION S-f-' Q �. S DEPTH C9
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /q .7 474.411jAAlJIHPOL RR€FERENCE .L•OWER•
TYPE OF Pa"ECTIO ) LENGTH FROM
OWNERS PERMIT $ I 00
-Y EURQ _R"_ M.L.TO P.L. 42
�
AUTHORIZATION ,TOTAL FEE X
HAVE 11 DATE CONTRACED W TH THEAED
CON RACTOIR TO CONNECT THE ABOVE DESCR BEDI EXIISTING APPROVALS INSPECTOR'S SIGNATURE. DATE
DWELLING TO THE PUBLIC SEWER `
.7 s NEW HOUSE SEWER
SIGNED THIS.-.41'.-DAY-OF. ........ _...��......./._.._.._.19.__...
OWNER OR / �/�) CONNECT ADDITIONAL
WORK
OWNERS AGENT-----..... ......_....._i............_....--------_ BUILDING OR WORK
�J v SEPTIC TANK,SEEP.PIT(S)
AD D RESS...�a_ "41—--------A..Q...... ......._.................. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL�
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT S Q CESSPOOLS ���1
SIGNATURE ( //Yr,., ( )
OF PERMITTEE..._.__ ..�.. ...__._...._.
'i 6A642D 663 1/53 �,� D,<r