HomeMy Public PortalAbout9166 LA ROSA DR_Sewer__ • t I
CITY OF TE0M,'CITY '
642D Q_62
76AAPPLICATION FOR PERMIT
78A842
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. I.AI')IBIE; County Engineer ADDRESS
9166 Ta Ras.1 Dra
WILLIAM A. JENSEN, Supt of Building
LOCALITY TaMple
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CROSSRt
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NEAREST ERcia
FOR APPLICANT TO FILL IN (1 j
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DESCRIPTION LOT NO 1 OWNER �/®DZUPlTity t Rosa
�� 1r MAIL 1L JA Rosa Dr
BLOCK TRACT ADDRESS v�1j} n�L�-
SIZE OF LOT NOW OON LOTS None CITYTO le Cit TEL. NO. 2663 L2
USE OF CI� DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS DISTRICTNO.
BK PG
CONTRACTOR Aere.Plumbing Co.
ADDRESS ;2845 N. Durfee Aire. 2 CONNECTION DATA
CITY El Monte �J/��,Ty(EL. NO GI "- STATION DEPTH
STATEIf
REGISTRATION NO 229768 68 C-36, COUNTY MANHOLE REFERENCE ' ` LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L. ML TO P L ;:O
1 PUBLIC SEWER @ $5 00 54W a
SEPTIC TANK.SEEPAGE PIT OR
NP C NO. C UPITS AND�OR DRAINFIELD @ YIO 00 CO IMP NO. JOB NO �J
HOU 5E SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR NO. DATE
+WORK TO HOUSE SEWER @ $300
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
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL ; ��-•r�j^ d'�� ��2-
CHARGES
OWNERS PERMIT $ 2 00
AUTHORIZATION TOTAL FEE 71W
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 SIG NATUiRE
SIGNED THIS DAY OF 19_
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 ElDRYW ELL [:1
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGL S COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGA WNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB DESCRIBED ES DENTIA E Y ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
CK.
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CASH
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