HomeMy Public PortalAbout9436 LA ROSA DR_Sewer__ &E-663 11.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 7
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. '
LEGAL - OWNER
DESCRIPTION LOT N0.
MAIL - - - - - - '
BLOCK TRACT - ADDRESS '
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
UI DISTRICT OF
B - CT NO. GROUP - MAP
BUILDINGS BK OP_S
CONTRACTOR0pl f/'-
CONNECTION DATA
ADDRESS
�S STATION DEPTH
CITY EL. NO. L/ MANHOLE REFERENCE UPPER
Ee'SI'ATE LOWER
REGISTRATION N0. ❑ COUNTY '
NO. DESCRIPTIO OF WORK FEE
TYPE OF CONNECTI NP. ENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB M.L. TO P.L.
PUBLIC SEWER @ $3.50 ,
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD - @ $3.00 _
OVERFLOW SEEPAGE PIT,DRAINFIELD C. NO,
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. OB NO.
HOUSE SEWER CONNECTING TO - -
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO R D PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACH NT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR D PO AL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE '
OWNER'S- PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE.
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
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 41.
OWNERS AGENT SEPTICTANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I 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 REOUIRED BY LOS GELES COUNTY ND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM T LEGAL. OW ER THE ABOVE _
DESCRIBED RESIDE P P Y, BACKFILL SEPTIC TANKS[:1SIGNATURE �
SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTE - '
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH
LACo c3 7 9 JUN, 4 . 2' 2.0 Li �
D
S&IE-663 9.53 APPLICATION FOR PERMIT 1
8&6.8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
MINE
FOR APPLICANT TO TML NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT N0. . 3, OWNER
BLOCK TRACT ��� 9 MAIL ,
J ADDRESS
N OF BLDGS.
SIZE OF LOT OW ON LOT CITY TEL. NO..
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
PG
CONTRACTOR LK
ADDRESS / J CONNECTION DATA C�
CITY TEL. STATION 3�, GF DEPTH 6
���Y A7/SIATE MANHOLE REFERENCE UPPER
REGISTRATION NO. /Y_ ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE 'L'Qf�N ECTION LENGTH-FROML.
Y. CURB J P.L. M.L. TO PP L. syr[
PUBLIC SEWER Q $ 3.50
HOUSE SEWER. CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. ORP
. C. N0.
_ WORK TO HOUSE SEWER 1.00 CO. IMP. NO. 1 JOB NO.
ALTER OR REPAIR EXISTING /Ooh �y
SEWER OR DISPOSAL SYSTEM 00 TRUNK PERMIT NO. ROAD PERMIT NO. C
DISCONNECT AND ABANDON SEWER ENCROACHMENT
STATE ENC
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR c�
PITS AND/OR DRAINFIELD ,00 IN&STRIAL
CESSPOOL• DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNER'S PERMIT S ' CONNECTION CHARGE FEE
OO
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THF�ABOVE DESCRI ED LISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SE .
SIGNED THIS '"QDAY OF 19 4 % NEW HOUSE SEWER _r r ".
OWNER OR
�-sc CONNECT ADDITIONAL `k--jOWNERS AGENT '�' BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI CESSPOOL❑ DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA, OR THATI THE LEGAL OWNER OF ABO -ABANDON HOUSE SEWER
DESCRIBED RESIDENT P PERTY. BACKFILL SEPTIC TANKS[I- SEEP. PITS) ❑ CESSPOOLS ZS
SIGNATURE
OF PERMITT '
Nil
WILLIAM J.FOX. COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
X5000 FEB 11 4 4.50
I .