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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 .