HomeMy Public PortalAbout9458 LA ROSA DR_Sewer__ DEPAIiTDlENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL.
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
- WILLIAM J. FOX, COUNTY- ENGINEER BUILDING
ADDRESS
FOR APPLIICCANT-TO-ALL IN LOCALITY
BUILDING �� `mow/ f:. CR0SS ST.
EST
ADDRESS TS •
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST A 7,F 7 S
CROSS ST.
RECEIVED By Ready for Inspection DATE ISSUED
QWNER -
ADDRESS USE ZONE y OCCUPANCY
ADD2J
Q .SK'—'"PG's �
CITY TEL.NO.
CONTRACTOR , Lam! C� SV'4.0 '
CO.IMP.N0.
ADDRESS JOB JOB NO.
CITY 0_e46 / TEL.NO. TRUNK PERMIT NO. '
�/ ❑❑ STATE
REGISTRATIONNO�yJ-�J'G�� c�"T� 1=]=COUNTY ROAD PERMIT N0.
LEGALL6i�OT O. �� STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT /'13:12 WASTE APPROVAL
SIZE CF LQT J �y d ANO.OF BLDGS.
r67P X 6C) NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESC IPTION OF WORK FEE REIM13IRSEMENT FEE
HOUSE SEWER CONNECTING TO 'L►^
PUBLIC SEWER @ S 3.50 V U RECEIPT NO. I ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEP ON RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING t tJ0' I DATE
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSP00 L—D RYW ELL- /
SPECIAL CONDITIONTONLY 2.00MAll1PPE REFERS E � '
,. TYPE OF CTION - LENGTH FROM
I V� CURB cP;m M.L.TO P.L.
OWNERS PERMIT ; I 00
AUTHORIZATION TOTAL FEE 2/ -
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
.19_ �-
SIGNED THIS..__.g___—._DAY OF_._...:____._ .._...W.. NEw HOUSE SEWER ,���„� •,�'����-`
OWNER OR " - CONNECT ADDITIONAL
OWNERS AGENT.".'Y___ / BUILDING OR WORK
��• cl SEPTIC TANK,SEEP.PIT(S)
ADDRESS- '2L ---------•------.-._--_- AND/OR DRAIN-FIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL E
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
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED IESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SEEP.PIT(S)[] ,CESSPOOLS
SIGNATURE
OF PERMITTEE
LN,78AB42D 663 1/53