HomeMy Public PortalAbout9151 LA ROSA DR_Sewer__ CITY OF TEMPLE C ITY
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76A642D APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
151 T_ Rosa �I'e
JOHN A. LAMBIE, County Engineer La
WILLIAM A. JENSEN, Sup't of Building Temple City
nC 8
FOR APPLICANT TO FILL IN (?
DESCRGPTION LOT NO f f7 OWNER �OmllTllt Dis RockenbachISY
BLOCK TRACT Jl( MAIL 10128 Eo Rush Sty
ADDRESS
/��T(•� NO OF BLOGS. �T op Monte
ui_ 89
SIZE OF LOT 21OX80 NOW ON LOT None CITY TEL. NO.
USE OF DISTRICT NO. GROUP MAP PRO
BUILDINGS
BK PG
CONTRACTOR Aero Plumbing Go. �� f O F
ADDRESS 2845 N.Durfee Ave. CONNECTION D TA
CITY EI MonteTEL NO. GI 246M STATION DEPTH
STATE MANHOLE REFERENCE �y UPPER
REGISTRATION N. 238485 COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH F OM
1 HOUSE SEWER CONNECTING TO Y CURB P L. M L.TO .L � d
PUBLIC SEWER @ $5 00
PC NO
SEPTIC TANK.SEEPAGE PIT OR O
PITS ANDOR DRAINFIELD @ 51000 CO.IMP NO V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. Q[
PRIVATE DISPOSAL SYSTEM @ S300 0
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD. INSTR NO DATE
WORK TO HOUSE SEWER @ $300
OVERFLOW SEEPAGE PIT,DRAINFIELD W
EXTN,CESSPOOL,DRYWELL MANHOLE @ $500 n'
ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT Z
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT 3 2 Oo CHARGES
AUTHORIZATION I TOTAL FEE 7 00 CONNECTION CHARGE FEE
IHAVE 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_ �f!
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
1 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 El AND SEWERS CESSPOOL DRYWELL
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL O ER NTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV SCRIB RE TI PROP TY. ABANDON HOUSE SEWER
L:�OF
NATURE BACKFILL SEPTIC TANKS ❑
PERMITTEE SEEP.PITS) ❑ CESSPOOLS ❑
OVALIDATION ROBERT A. WOOD
cK M O CASH SUPERVISING,MECHANICAL ENGINEER
L ACO,8 6 3 9L�-o My 19 1 0 0 7.0 0