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HomeMy Public PortalAbout9167 LA ROSA DR_Sewer__ A642D 76A642 0-63 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING O JOHN A. LAMBIE, County Engineer ADDRESS y WILLIAM A. JENSEN, Supt of Building � ////�/� /y!r V LOCALITY -`/�� /-' �i 7 NEAREST Ri FOR APPLICANT TO FILL IN 77CRD55 5T. q 0-Y LEGAL DESCRIPTION LOT NO 1V OWNE 7 A MAIL BLOCK TRACT (yl I 7 ADDRESS NO OF BLOGS. SIZE OF LOT NOW ON LOT CITY TEL NO. USE OF r�^^ BUILDINGS V v DISTRICT NO GROUP MAP PROCESSED BY �O(J(,// 41 BK PG /1 CONTRACTOR V UN r N i-')P-Y- ADDRESS r CONNECTION DATA CIT EL. NO STATION DEPTH r REGISTRATION NO COUNTY MANHOLE REFERENCE STATE Q tel! OWER NO. DESCRIPTION OF WORK FEETYPE OFC I LENGTH FROM N f HOUSE SEWER CONNECTING TO $g.00 5 00 Y RB P.L M L TOP.L. PUBLICSEWER J } PC NO SEPTIC TANK,SEEPAGE PIT OR O PITS AND OR DRAINFIELD CO IMP. NO.@ $10 00 JOB NO Cv! ,L�.- HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 dw CONNECT ADDITIONAL BLDG OR O O AFFIDAVIT WAIVER EASEMENT RECORD INSTR.NO DATE O WORK TO HOUSE SEWER 0 3300 OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN,CESSPOOL,DRYWELL,MANHOLE @ $5 00 d ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING H SEWER OR DISPOSAL SYSTEM @ S3 00 STATE ENCROACHMENT?, O,, I �[t /�,w`p z PERMIT NO GG,, INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 21 00 CHARGES AUTHORIZATION TOTAL FEE 1 1 00 CONNECTION CHARGE FEE '1 HAVE AT THIS DATEA CON R GT WIT THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE I O E E RIBED XIST ING DWELLING TO THE PUBLIC SEWER / APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS AY O 19_ �/)� �• ,'n OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL � , BUILDING OR WORK t ' Xa ADDRESS r SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT I AVE 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 IHEREBY CERTIF THAT I A OPERLY R GISTERED AND/OR ALTER REPAIR,SEWER OR LICENSED AS RE IR BY 0G ES CO TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR AT AM TH LEGA NE F. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV D CR ED R I N L PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(5) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M O. CASH '� { LAAO 3 9 1 71 SEP 17 1 0 D 1 0.0 0 S&E-66311-SS _ i� AP9 LICATIONTOC \ PERMIT DMSION OF BUILDING AND -SAFETY SEWER-SEW - DISPOSAL Department of County Engineer < County of Los Angeles BUILDING r s JOHN A. LAMBIE, COUNTY ENGINEER- ADDRESS. _ jr•t�• �•c•vs,.- ,r ' ® CASSATT D_ GRIFFIN, SUP'roF BUILDING LOCALITYFOR APPLICANT TO FILL'IN' NEAR sr . ILEGAL DESCRIPTION LOT NO. L�C y- O/� OWNER BLOCK TRACT MAIL - ADDRESS • N0. OF BLDGS. CITY ..i TEL. NO SIZE OF LOT NOW ON LOT �' c USE OF 3 DISTRICT NO. GROUP MAP _ BUILDINGS 4r' _lam '- BK PG CONTRACTOR - _ ���- a-•cam V ' 1 CONNECTION DATA ADDRESS �'' G�f ''�.''"fi 1-i-8�!.Z'1..' . STATION - DEPTH Y CU. TEL. NO. MANHOLE REFERENCE J c UPPER �/ - +,� ❑ STATE LD�LJip'-.� / LOWER REGISTRA, ON NO. ❑ COUNTY NO. 'DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO ' TYPE OF CONNECTION LENGTH FROM - PUBLIC SEWER @ $3.50 Y-, CURB P.L. M L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD - P'. C. NO. ` EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO. 10B NO. HOUSE SEWER CONNECTING TO , PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT,ADDITIONALBLDG,ORSTATE ENCROACHMENT - WORK TO HOUSE SEWER Q $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ' 'ALTER, OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE - OWNER'S PERMIT g 1 00 AUTHORIZATION TOTAL FEE ` r� REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO'THE PUBLIC SEWER. - - NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR - BUILDING OR WORK - �^ OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL F1 DRYWELL❑ AN D- THAT,THE ABOVE IS CORRECT AND AGREE TO-COMPLY ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR ' PLUMBING' AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT'PLUG•AND LICENSED,AS.REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER ' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ' DESCRIBED RESIDESi,WNA- PROPERTY ;;y"!!�� BACKFILL SEPTIC TANKS El _ SIGNATURE ��/' r�^�'.✓QuLa/''���. SEEP..PITE)S) CESSPOOLS❑ .- . f OF PERMITTEE - JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG:•INSPECTOR CK. M.0. -CASH AP_5,,7�6 5� ��� - 7 4 2.00 -76A 3 11-55 APPLICATION FOR PERMIT 8E8E-68DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of LOS Angeles BUILDING JOHN A. L'AMBIE, COUNTY ENGINEER ADDRESS.�,s ® CASSATT D. GRIFFIN, SUP'T.OF BUILDING LOCALITY / FOR APPLICANT TO FILL IN CROSS srJG LEGAL -a.OWNER DESCRIPTION LOT NO. /� BLOCK TRACT ADDRESSo— MAIL �7� NO. OF BLDGS. CITY TEL. N0. SIZE OF LOT NOW ON LOT USE OF �yJ�� DISTRICT NO. GROUP A BUILDINGS TC I / f BK PG CONTRACTOR .w 00; ADDRESS! !ngo �fy�f�/7 ��� CONNECTION DATA CITY EL. NO, 6 i'x STATION ' � � DEPT MANHOLE REFERENCE dp VIPPER STATE REGISTRATION NO. ( ❑ COUNTY , NO. DESCRIPTION OF WORK FEE TYPE O TION_ LENGT - ROM HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L.TO ,.L. SEPTIC TANK,SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD Q $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. 37 7 JOB O. EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2.00 HOUSE SEWER CONNECTING TO r,. PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. OA P T N 2, CONNECT ADDITIONAL BLDG.OR �® STATE ENCROACHME WORK TO HOUSE SEWER @ $1 00PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL •SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL - CH RAS CONNECTION CHARGE E ` ' OWNER'S PERMIT $ 1 00 fI - AUTHORIZATION TOTAL FEE 01. w REIMBURSEME T FEE OVVI HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPR DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED'EXISTING DWELLING TO'THE PUBLIC SEWE NEW HOUSE SE E „, Q SIGNED THIS DAY C 1 CONNECT ADDITIONAL Y OWNER OR BUILDING OR WORK OWNERS'AGENT ' SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING' ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. • SEWAGE DISPOSAL SYSTEM 'I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW ER CALIFORNIA OR THAT I .A'M` THE LEG L.OWNER OF THE ABOVE DESCRIBED RESIDENTIA PE Y. BACKFILL SEPTIC TANKS❑ k SIGNATURE SEEP. PIT(S) EJCESSPOOLS©—1 OF PERMITTEE I�1' JOHN A. LAMBIE, COUNTY ENGINEER LIDATION__ ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. N'O. GASGAS�I ' 36- 02 rEB29 4 5.50 76A642 0'82 APPLICATION FOR PERMIT � / 78A842D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL IUI DEPARTMENT OF COUNTY ENGINEER BUILDING AND. SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS r,4 WILLIAM A. JENSEN. Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST B j,'&& 2 JW.S/i . LEGAL DESCRIPTION LOT NO - ` OMAIL WNER / Bs�/BLOCK TRACT � ADDRESS � c�T,rL/Jr YO, N OF BLDGS ��- / ,7 SIZE OF LOT ,//G/pfS,NOW ON LOT CITY ��/� 1r 1,7 EL NO. ✓��� USE OF DISTRICTNO' GROUP MABK P PROCESSED,BY BUILDINGS - / J�J PG CONTRACTOR lr Wii ADDRESS CONNECTION DATA CITY TEL NO vv STATION DEPTH STATE MANHOLE REFERENCE / UPPER -REGISTRATION NO COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR M HOUSE SEWER CONNECTING TO Y. CURB P'L. M L TO P.L O PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR J C NO- . NO.. V PITS AND/OR DRAINFIELD @ 51000 CO IMP NO HOUSE SEWER CONNECTING TO TRUN PER P O _ O PRIVATE DISPOSAL SYSTEM $300 i CONNECT ADDITIONAL BLDG OR AFFIDAVIT AI ER EASEME T RECORD I STR DATE WORK TO HOUSE SEWER @ $300 _ Q. OVERFLOW SEEPAGE PIT,DRAINFIELD N EXTN,CESSPOOL,DRYWELL,MANHOLE @ $500 Z A .Ar3tEPlrHrOR ABANDON HOUSE HWY OR ST WIDENING SEWER <Yc $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES ON AUTHORIZATION TOTAL FEE CONNICHARGE 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 INSPECTOR'S SIGNATURE SIGNED THIS DAY OF _19- OWNER OR -� NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL • r - BUILDING OR WORK - ADDRESS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE,ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS' CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM'PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS NGLES COUN Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I A THE GAL O ER AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE SCRI D RE N A P 1ERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) Cl CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SU,PERVISING MECHANICAL ENGINEER CM O ('K 2 ^y ( CAS 0 Do- J hJ4