HomeMy Public PortalAbout9156 LA ROSA DR_Sewer__ CITY OF TWLE CITY
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76A642D APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A. LAMBIE, County Engineer 1 La Rosa Dr.
WILLIAM A. JENSEN, Sup't of Building City y
Te 1e Cit '
ECICin�taFOR APPLICANT TO FILL IN 7 L �p
LEAL
DESCRIPTION LOT NO 3 OWNER (munity Disposal,
MAIL
BLOCK TRACT 28317 ADDRESS 9167 La Rosa Dr.
SIZE OF LOT
1WX70 NOWOON L TS AOAe CITY Temple CityL. .NO.AT 63342
USE OF DISTRICT NO I GROUP MAP PR ESSED BY
BUILDINGS
BK PG y
CONTRACTOR Aero Plumb Co. ,j�0 F 5 /L�"�
ADDRESS pp26��4��5 N.Dwfea Ave. CONNECTION DATA
CITY jtiJ�YOnte- TEL No 238485 Co*36 STATION at DEPTH
STATE MANHOLE REFERENCE �// '� f UPPER
REGISTRATION NO - GI 24600 ❑ COUNTY i/ L
NO DESCRIPTION OF WORK FEE TYPE OFLENGTH FROM /
HOUSE SEWER CONNECTING TO Y CURB P L M L.TO P L °J
PUBLIC SEWER $5 00 900 CL
}
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ 51000 CO IMP NO
V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIBn WAIVER CASEMENT RECORD.INSTR NO DATE O
WORK TO HOUSE SEWER @ $3 00 F�
OVERFLOW SEEPAGE PIT,DRAINFIELD W
EXTN..CESSPOOL,DRYWELL.MANHOLE @ $5 00
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 s 2 00 CHARGES
AUTHORIZATIONTOTAL FEE 7 CONNECTION CHARGE FEE
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 INSPEC OR'S SIGNATURE
SIGNED THIS DAY OF 19_ i
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 IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ O
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL QFWVER OF, AND I TEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV CRIB RE D TIAL ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS EL
VALIDATION ROBERT WOOD
CK. M o CASH SUPERVISING MECHANICAL ENGINEER
LhLo 1 6 4 6 APR 29 1 0 D 7.0 0— °v'