HomeMy Public PortalAbout9143 LA ROSA DR_Sewer__ / »0rey ' •.
76A6426 APPLICATION FOR; PERMIT
COUNTY OF LOS ANGELES it SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION' BUILDING'
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Sup't of Building ADDRESS
PIG
LOCALITY
NEAREST ,
FOR' APPLICANT TO FILL IN CR055 5T.Eno
LEGAL
DESCRIPTION LOT NO` a OWNER q l '
1p
MAIL
BLOCK TRACT .. ADDRESS
SIZE OF'LOT_ NOW ON LOT CITY TEL NO -on
USE OF
BUILDINGS ,DISTRICT'NO •'ROU P MAP PROCESSED BY -
BK PG �
CONTRACTOR •, 4 I /" 8 te'.,•�r .r�:'' A„ ,
"ADDRESS
CONNECTION'DATA
t' f
CITY -' TEL NO - STA ION DEPTH 'IF r
Yts s I''7y STATE, j IPOEIR•
REGISTRATION NO -�1 COUNTY MANHOLE REFERENCE•• �pVyER
I NO. DESCRIPTIO ORK FEE TYPE OF CONNECTION LENGTH FROM 1"
HOUSE SEWER CONNECTING TO Y. CURB r P L, M L TO P L 0
0
y PUBLIC-SEWER I@ 55.00 P.C.NO
SEPTIC TANK,SEEPAGE PIT OR. - CO IMP. NO. - - JOB NO. ,��
PITS AN DOR DRAINFIELD . @ $1000 "
r W
HOUSE SEWER CONNECTING TO ,..�
PRIVATE DISPOSAL SYSTEM @ $3 00 - TRUNK PERMIT NO. ROAD PERMIT NO
1 CONNECT ADDITIONAL BLDG,OR AFFIDAVIT wAIVEY [AS EN[NT RECORD. INSTR NO. DATE
WORK TO HOUSE SEWER @ $3 00 >
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN,CESSPOOL,DRYWELL,MANHOLE @ $500 - -
ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
;SEWER OR DISPOSAL SYSTEM @. $300 STATE ENCROACHMENT O ,
- - PERMIT NO
` INDUSTRIAL
{ � WASTE APPROVAL
CHARGES
1 OWNERS PERMIT s, 2 00
AI UTHORIZATION -TOTAL FEE- CONNECTION CHARGE FEE '
' '
I REIMBURSEMENT FEE
EE HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY O,F 19_
OWNER OR NEW-HOUSE SEWER
OWNERS AGENT- '
„ ) - CONNECT ADDITIONAL
• 3 �
-BUILDING OR WORK•
ADDRESS • '
SEPTIC TANK,SEEP,PIT(S) _
-I I' HEREBY ACKNOWLEDGE THAT. 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD -
AND STATE THAT THE ABOVE IS*CORRECT AND AGREE TO COMPLY _WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING • -
PZLUMBING AND SEWERS CESSPOOL '❑ •DRYWELL ❑
41 HEREBY CERTIFY THAT.1 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�•OWNER OF, AND INTEND TO DISCONNECT PLUG AND -
RESIDE IN, THE ABOVE DESCRIBED RES I DENT]A L,,!-,ROPE RTY. ABA'NDONIHOUSE SEWER '
J' f
5 GNATU RE ,�r �,1�„_,4 ❑
-p OF PERMITTEE X ,,,d l,,f"`• BACKFILL SEPTIC.TAN KS
ds4 �- w.-,• SEED.PIT(S) El LS ❑
r•>.,VALIDATION ROBERT A. WOOD`
CK. M o CASH SUPERVISING MECHANICAL ENGINEER '
CIM OF TEMPLE CITY
3-64
76A642D APPLICATION' FOR PERMIT
6A64 ,
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING D
JOHN A. LAMBIE, County Engineer ADDRESS 9143 La Rosa Dr.
WILLIAM A. JENSEN, Supt of Building LOCALITY Temple City
NEAREST Encinita
FOR APPLICANT TO FILL IN CROSS T.
DE,LEGAL LOT NO 6 it •3 S 1
OWNER
28317 MAIL -
BLOCK TRACT
� ADDRESS 10128�,{E ffush St
SIZE OF LOT 70f�j+.��Of� NOWOON LOTS None CITY SOGFJ3 Onte TEL. NO. GI4+55 8 9;
USE OFC DISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS
BK PG
CONTRACTOR Aero Plumbing Co. S p S
ADDRESS N.Durfee Ave_. CONNECTION DAT/A
El Monte STATION /
a7 DEPTH 7O
CITY TEL NO �J� "
REGISTRATION NO 23 84 85 0 36 ❑ COUNTY AJ STATE MANHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIO(N/ L_ LENGTH FRO M y
1 HOUSE SEWER CONNECTING TO \ Y. CURB P.L. _ML TO P L S
PUBLIC SEWER @ E3 00
SEPTIC TAK,SEEPAGE PIT OR P.C.NO
PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO.
N /Ff� O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. V
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD, INSTR NO. DATE O f
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN,CESSPOOL,DRY,WELL,MANHOLE @ $500
ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM @ S3,00 STATE ENCROACHMENT N
PERMIT NO ,z
INDUSTRIAL
WASTE'APPROVAL
CHARGES
OWNERS PERMIT S 2 00
AUTHORIZATION TOTAL FEE 7,00 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 I NSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL '
BUILDING OR WORK
ADDRESS SEPTICTANK,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
WIT HALL 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 1 AM THE LEGA OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE-DESCR BED DEN AL PR PERTY ABANDON HOUSE SEWER
SIGNATURE �/ BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP,PITS) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK M O CASH SUPERVISING MECHANICAL ENGINEER
APR 2 0 •1 0 D 7.a Q