HomeMy Public PortalAbout10239 LA ROSA DR_Sewer__ J8A842DAPPLICATION FOR PERMIT 1
s&E-663 1196
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depaxtment of County Engineer _
County of Los Angeles BUILDING /7',
_
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUP'T Or BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL / OWNER
DESCRIPTION LOT N0. Sa /��j [� _
AIL
BLOCK n TRACT
/ 13� .3� .A1D1E55 /0,9 t
SIZE OF LOT (G/� �b� N0. OF BLDGS. / CITY /�yj. TEL. NO.
NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
BK PG
CONTRACTOR
ADDRESCQS]����,, — ,y"l.z CONNECTION DATA
.�L'V✓1.` v6G k C. 77 STATION DEPTH
CITY NO. /
MANHOLE REFERENCE t _ / UPPER
REGISTRATION NO. G l JS ❑ COUNTY /' ' �j`' '
NO. DESCRIPTION OF WORK' FEE
TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO �-0 Y. UR P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50 y
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD R $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C.
EXTN..CESSPOOL,DRYWELL,MAN HOLE @ $2.00 r CO. IMP. NO. .JOB NNO0.
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM a S 1.00 TRUNK PERMIT NO.. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
_ SEWER OR DISPOSAL SYSTEM C $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE.FEE
OWNER'S PERMIT $ 11 DO
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE L{k�'
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTORSSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESC IBED EXISTING DWELLING '
TO THE PUBLIC.SEWER. NEW HOUSE SEWER y
SIGNED THIS DAY OF 19.5 8 - � ,
CONNECT ADDITIONAL
OWNER ORti. �. BUILDING OR WORK
OWNERS AGENT `�'u�� r
SEPTIC TANK,SEEP,PIT(S)
ADDRESS ANO/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
SEWER
DESCRIBED RESIDENTIAL PROPERTY. ACK/��
SEEP.FPLT (SE P CESSPOOLS ED
SIGNATURE 1
OF PERMITTEE � A 'l
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIOfI'�� ROBERT/A.'WOOI3 CHIEF/LP1LOGG.. INSPECTOR
CK. M. 0. .7k/"•OsN/p
4.50 n