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Home My Public Portal About9142 LA ROSA DR_Sewer__ CEBOB 3-64 76A6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /1 JOHN A. LAMBIE, County Engineer ADDRESS 4 WILLIAM A. JENSEN, Sup't of Building %f LOCALITY l NEAREST FOR APPLICANT TO FII.L IN CRD55 ST. LEGAL f^ DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT 1 ADDRESS NO OF BLDGS. SIZE OF LOT 0 NOW ON LOT CITY TEL. NO. USE OF BUILDINGS i'L f-- DISTRICT NO GROUP MAPPROCE ED BY BK PG CONTRACTOR �� 23 .7 L ADDRESS ///iii CONNECTION DATA CITY it /� TEL NO 6 STATION /0 DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO. /9 72 7 COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L TO P.L. PUBLIC SEWER @ 55 00 P C NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO a PITS AND/OR DRAINFIELD @ $1000 CO.IMP. NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V PRIVATE DISPOSAL SYSTEM S3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIV[R I [ASLMCNT RECORD. INSTR NO DATE O WORK TO HOUSE SEWER @ $300 ` OVERFLOW SEEPAGE PIT.DRAINFIELD 3. EXTN.,CESSPOOL,DRYWELL.MA NH OLE @ $5.00 VVV ALTER,REPAIR OR ABANDON HOUSE HWY OR ST.WIDENING IW SEWER OR DISPOSAL SYSTEM ® $3.00 STATE ENCROACHMENT cn PERMIT NO. ti INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE S CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF ' - 19 OWNER OR '/�' NEW HOUSE SEWER OWNERS AGENT- ley CONNECT ADDITIONAL ADDRESS BUILDING OR WORK _ SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESID TIA OF, ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD CK M O. CASH SUPERVISING MECHANICAL ENGINEER L -6 0 3 .2ZE NOV2 5 1 0 0 5.00- g CITY OF TWLE CITY CE864 2D 5-65 76AAPPLICATION FOR PERMIT 76A 64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LANIBIE, County Engineer ADDRESS 9142 La Rosa Dr. COLENIAN 8. JENKINS.Supt. of Building Temple Cit LOCALiTV NEAREST Encinitas FOR APPLICANT TO FILL IN CROSS 5T. En DESCRIPTION LOT NO OWNER(COminity DiLc} LEAL sg/RockenbacY��nl Con BLOCK TRACT l) ADDRESS lO�8 E.Rush S�/• -1 NOBLDG SIZE OF LOT o � !/ �5 NOWOON LOTS CITY So.E1 MonteTEL NO. GI 45589 USE OF DISTRICT NO I GROUPMAP PROCESSED BY BUILDINGS Gmml - ,,/G / BK PG CONTRACTOR Aero Plumbing Co. �', �(/ �F- �: ADDRESS 2845 N.Durfee Ave. CONNECTION DATA // CITY El Monte TEL ,,GI 24600 STATION '14/� DEPTH J_ r (�/ G' UPPER NOCE NSE 2 5 CLA SSLICENSS C-�3 MANHOLE REFERENCE NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION L LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB M L TO P L PUBLIC SEWER C $ 5 00 >. SEPTIC ANK, SEEPAGE PIT OR PC NO• a PITS AND/OR DRAINFIELD @ $10 00 CO IMP NO. Q6111bw . 6 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $ 3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ $ 3 00 R ABANDON HOUSE U SEWER OR DISPOSAL SYSTEM C $ 3 00 HWY ORST WIDENING CL H EXTN.,CES S POOL, MANHOLE @ $ 5 00 cn STATE ENCROACHMENT PERCOLATION TEST @ $ 5 OG PERMIT NO INDUSTRIAL WASTE APPROVAL OWR NE $ PERMIT t � i 00 CHARGES AUTHORIZATION I TOTAL FEE •00 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TOCONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTO SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL O R OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV CRIB RES E TIA Y. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK M O, CASH ul,0 4 7 9 3- SEF 16 1 0 D 7. `0