HomeMy Public PortalAbout9463 LA ROSA DR_Sewer__ DEPAlirMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION.-OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX._COUNTY ENQINEER BUILDING
ADDRESS �.a, dS9L
FOR. APPLICANT
FILL IN LOCALITY
BUILDING NEAREST
ADDRESS ef� CROSS S .
v •c=,I✓I ILA Aye-
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST V A �- ��z% S
3
CROSS ST.
ECEIVED BY Ready for Inspection �D/^AT ISSUED
OWNERit POEM= a er-
MAIL USE ZONE OCCUPANCY MAP
ADDRESS � BK PG
CITY TEL.NO. i16
�
CONTRACTOR X e9
CO.IMP.NO.
ADDRESS >�
JOB NO. C I�I� "r' i G
CITY y.� 1 TEL.
gNO.�Cf� f y��/� TRUNK PERMIT NO.
REGISTRATION N0. 9JOUNLJ
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
- PERMIT NO.
BLOCK TRACT Jdel INDUSTRIAL r
N0.OF BLDGS. WASTE APPROVAL fE
SIZE OF LOT' � 1�� NOW ON LOT OHARGES' -
USE OF
BUILDINGS CONNE N CHARGE FEE
NO. DESCFIIPT113W OF WORK FEE
HOUSE SEWER CONNECTING TO r REIMBURSEMEN E
PUBLIC SEWER @ $ 3.50 U Q RECEIPT NO. DATE I BY
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 18Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER CONNECTION DATA c
AND/OR DISPOSAL SYSTEM 1.00
SEPTIC TANK.
_ PTS AND/OR DRAINFGEI ELDIT OR 2,00
CESSPOOL—DRYWELL STATION / -C� —3DEPTH s
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE _)C
A O! LOWER
TYPE OF CONNECTION LENGTH FROM"
OWNERS PERMIT = I Op t''CURB j aAn " M.L-.TO P.L.
4�-
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING- APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE
rrP��UBLIC SEWER
SIGNED THIS---1_!_-_-.-DAY OF..-..-. 196-s NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.....--.ti- -----------••••---." BUILDING OR WORK
ADORES S....... -. ... - -. L-:--T R SEPTIC TANK,SEEP.PIT(S)
�zQlal AND/ODRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL I]
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY, LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL-OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
'
SIGNATURE �®®/� i A /f SEEP.PIT(S)E] CESSPOOLS M �� s
/j�y�L'� 'G�^"fG
OF PERMITTEE-=•�--=----.--:.._------- •----=_•._...--•:;•--._..
70A042D 663 1/53 �y �+