HomeMy Public PortalAbout9150 LA ROSA DR_Sewer__ 0=63
76A642D APPLICATION FOR PERMIT
6A642u
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER 44��� DD����
BUILDING AND SAFETY DIVISION BUILDING 9150 Jei lH7a�a Dr.
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of BuildingTemple City
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LOCALITY
NEARE
FOR APPLICANT TO FILL IN
G R.SS'ST Encinita
DESGAL IPTION LOT NO OWNER EOv ORockenbach(Gnl-Gontr)
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BLOCK TRACT 2831//! MAIL ADDRESS 10128 E1 .Rush Sty
NO
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SIZE OF LOT NOWOON L TS bone FTRUNK
SO. El MOn#� NO GI 45589
USE OF Cmmla . GROUP MAP PROCE D BY
BUILDINGS - BK PG
CONTRACTORAero Plum g oos _/ rADDRESS X2,+845 N.Durfee Ave, CONNECTION DATA,
CITY El MOnteTEL, NO GI 24 0 DEPTH
REGISTRATION NO 238485 ®36.. oCO NSTATE EFERENCENO DESCRIPTION OF WORK FEE F CONNECTION LE GTH FROM1HOUSE SEWER CONNECTING TO 5 CURB P.L" M TO P.L. 4�PUBLIC SEWER @ $5.00SEPTIC TANK.SEEPAGE PIT OR O
PITS AND/OR DRAINFIELD @ $10.00 .HOUSE SEWER CONNECTING TO IT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3 00 0
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR, NO DATE
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT.DRAINFIELD l!J
EXTN,CESSPOOL,DRYWELL,MANHOLE @ $5.00 - d
ALTER,REPAIR OR ABANDON HOUSE HWYR 5 WIDE G h
SEWER OR DISPOSAL SYSTEM $3.00 STA7E ENI qMIRNT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ 21 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE CHARGES
1HAVE AT THIS'DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT I
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PITS)
LANDA
BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
LL COUNTYORDINANCES AND STATE LAWS REGULATING
G AND SEWERS CESSPOOL ❑ DRYWELL ❑EBY CERTIFY THAT 1AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
D AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
NIA OR THAT I AM THE LEGA OWNER OF, AND INTEND TO DISCONNECT PLUG AND
IN, THE ABO DESC BED E IDENTIAL PR PERTY ABANDON HOUSE SEWER
RE BACKFILL SEPTIC TANKSRMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑
1 1
LIDATION ROBERT A. WOOD.
SUPERVISING MECHANICAL ENGINEER
CK M.O CASH
LAC67 a 3 1,10 FEB 7 1 0 -a 7.0 ON