HomeMy Public PortalAbout9429 LA ROSA DR_Sewer__ DEPARTMENT OF COUNTY-ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER �) BUILDING
ADDRESS
FOR A�jPPLICA T TO•FILL IN LOCALITY
ANEAREST
DDRESS /4 �V A ;1 "q CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST '
CROSS ST. /^� cz
RECEIVED BY Ready for Inepaction DATE
ISSUEDa/.y
OWNER /L
MAIL -e USE ZONE OCCUPANCY MAP
ADDRESS BK PG
CITY TEL.NO, a At-1 ( ::t
CONTRACTOR �,&�" C./ V.H U PAY!gr CO.IMP.NO. - 3(Z/ ��}lC2
ADDRESS Z :? F E. z?QC/V DA 4I JOB.NO.
� d
TEL.N0.4 4__�`7f TRUNK PERMIT NO."--
REGISTRATION NO. (,� ❑COUNT
P c Y ROAD PERMIT NO. .09 5!fSC
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT ® INDUSTRIAL
WASTE APPROVAL
S12E OF LOT— N0.OF SLDGS. / CHARGES
��• - •�Z NOW ON LOT
USOF
BUE DINGS CONNECTI HARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FE
j
HOUSE SEWER CONNECTING TO �q PUBLICSEWER a $ 3.50 1; H RECEIPT NO. AQ TE I BY
1• HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE I B
SEWER OR DISPOSAL SYSTEM 1.00
DISCON-AND/OR ABANDON SEWER
ORDISPOSAL 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR I
PITS AND/OR DRAINFIELD 2.00 STATION �j-{ ' I DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 3I _ MANHOLE REFERENCE LOWER
TYPE QF CONJ�ECTI MEL OHPFROM 5
OWNERS PERMIT $ I 1 00 �� RBl
AUTHORIZATION I TOTAL FEES
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER I
NEW HOUSE SEWER 11� �'
SIGNED THIS-_--" DAY OF_.._�.'��.� 19.s .SC�IY�C
CONNECT ADDITIONAL
OWNER OR
OWNERS AGENT.1% "� /YC!'-�:_•._. s••. ._ BUILDING OR WORK
/ SEPTIC TANK,SEEP.PIT(S)
ADDRESS..........._.._......--•-----..................................................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBE k RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS _
SIGNATURE \\\
n SEEP.PIT(S)C] CESSPOOLS ��jh I16 C
OF PERMITTEE- rti.. -
76A642A 663 7/53