HomeMy Public PortalAbout9162 LA ROSA DR_Sewer__ CITY OF. TMILE CITY
,D_Bz
7GA642D APPLICATION FOR PERMIT
78A 84
COUNTY OF LOS ANGELES' SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION' fA
UILDING
JOHN A. LAMBIE, County Engineer DDRESS
9162 Ta Ressa Dr.
ty
WILLIAM A. JENSEN. Sup't of Building s
OCALITY Temple J.
FOR APPLICANT TO FILL IN EAREST EnciAita
aoss sr
LEGAL /7
DESCRIPTION LOT NO OWNER Comuni Disposal
�[�
MAIL 7 n
BLOCK TRACT 28317I% ADDRESS 1V(� La AOsa DTQ
NO BLDG
SIZE OF LOT NOWOON LOTS None ' CITY Tem 1e City NO. 286ro3342
USEOF Cl
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
/?BK PG
CONTRACTORAare PljUnbing Coo
ADDRESS 28 N. Durfee Ave. CONNECTION DATA
CITY El Mol�te TEL NO (Ti 2 STATION DEPTH
22�IyLd ^��LV STATE MANHOLE REFERENCE
REGISTRATION NO 7/Cl'Q V COUNTY LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
1 HOUSE SEWER CONNECTING TO Y CURB P M L TO P.L O
PUBLIC SEWER @ $5 00
SEPTIC TANK.SEEPAGE PIT OR P C.NO V
PITS AND/OR DRAINFIELD @ SIOOO CO IMP NO JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG.OR =AIk EASEMENT RECORD INSTR N6J DATE
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN,CESSPOOL,DRYWELL.MANHOLE @ $500 HWY OR ST WIDENING
ALTER.REPAIR OR ABANDON HOUSE -
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL/{/,+
CHARGE
OWNERS PERMIT $ s o0
AUTHORIZATION TOTAL FEE 74 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 SEWERAPPROVALS DATE. INSPECTOR'S SIGNATUJRE
SIGNED THIS DAY-OF 19_
,
OWNER OR NEW HOUSE SEWER 1
OWNERS AGENT
CONNECT ADDITIONAL V L
ADDRESS BUILDING OR WORK
SEPTIC TANK,SEEP,PITS)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
L
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
L COUNTY ORDINANCES AND STATE LAWS REGULATING
G AND SEWERS CESSPOOL ❑ DRYWELL ❑
BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
AS REQUIRED BY LOS ANG COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
IA OR THAT 1 AM THE LEGA O NE OF AND I TEND TO DISCONNECT PLUG AND
N, THE ABOV ESCRIB SI ENTIA PRO Y ABANDON HOUSE SEWER
REBACKFILL SEPTIC TANKS ❑MITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK. M.o CASH SUPERVISING MECHANICAL ENGINEER
: . , 7 s o a JAN 2 2 1 0 D 7.Q Q N