HomeMy Public PortalAbout9503 LA ROSA DR_Sewer__ CC6808081111-87
S8 ' APPLICATION FOR PERMIT ..,.,. . -
COUNTY OF LOS ANGELESSEWER-SEWAG•E:DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, Count Engineer ADDRESS •• y ��
CASSATT D. GRF'FM, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO F l IN CROSS ST:
LEGAL A '''•
[REGISTRATION
ESCRIPTION LOT NO. OWNER
LOCK MAIL
TRACTADDRESS,
r - ADDRESS• �/�' O s7•t D
NO.OF BLDGS.
IZE OF LOT - NOW ON LOT CITY P TCL.'NO. '
SE OF
UILDINGS DISTRICT NO. GROUP MAP
uSO / j BK PG Jt
ONTRACTOR
DDRESS _ - CONNECTION DATA -
ITY - 3 TEL.N0. G STATION S DEPTH
NO. 72 ql) n, COUNTY— STATE MANHOLE REFERENCE R
LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $300
TYPE OFC CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR - Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO J J / P. C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.NO. / L// (� JOB N0.
CONNECT ADDITIONAL BLDG.OR '
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. _ ROAD PERMIT NO. +
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
_ INDUSTRIAL _
WASTE APPROVAL
CHARGES
OWNERS PERMIT. S. 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE'ATCON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE-A--CONTRACT-WITH THE I�NGAMED DWELLING _ APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW R
SIGNED THIS O
F i g NEW HOUSE SEWER
OWNER
.-
.. .. _ .._--_ - -� -- - -CONNECT ADDITIONAL---
OWNERS /AG T BUILDING OR WORK
ADDRESS 3'• - [9�C�- �Z•- _-- -,SEPTIC TANK,SEEP, PIT(S) - -- s -
•AND/OR DRAINFIELD' .•
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND_STATE_THAT TH_E ABOVE,•IS CORRECT AND AGREE-TO'COMPLY.. CESSPOOL-El DRYWEL-L 3^ - -•-' - ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
V HEREBY" CERTIFY-THAT I';A'M'-PROPERLY REGISTERED' AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM E •LEG L_ OWNER THE .ABOVE. ABANDON HOUSE SEWER_
DESCRIBED RESIDENTIA,L P ERTY. SEEP.PIT(S) CESSPOOLS El �`y~��•� L 6e+
• SIGNATURE _ -
OF PERMITTE -
OF VALIDATIO ROBERT—A:WOOD_
CK. M.•0. CASH SUPERVISING MECHANICAL ENGINEER
76A942D APPLICATION FOR PERMIT, 1.
ceeoe-a-as COUNTY OF LOS ANGELES , "
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING C� _
-JOHN A. LAMBIE, County E-gineor ADDRESS V l , [T Alc I�
CASSATT D. GBIPFIN. Supt of Building LOCALITY 1� 1--�
NEAREST
FOR APPLICANT TO FILL 1N
ST
EARE
CROSS ST. C�LCJV AT
LEGAL OWNERCS
DESCRIPTION LOT N0.
BLOCK TRACT 'MAIL
n of ADDRESS V
NO.OF BLDGS.
SIZE OF LOT �L NOW ON LOT CITY TEL.N0.
USE OF
BUILDINGS .� DISTRICT N0. GROUP MAP PROCESSED BY
CONTRACTOR L / /,
.J, (O
ADDRESS a r � ` CONNECTION DATA
CITY TEL. STATION' - DEPTH
STATE MANHOLE REFERENCE UPPER.
REGISTRATION NO. B COUNTY 'LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $9.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR Y. - CURB "" P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD 0 $8.00 - -
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NOl
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. _JOB NOC
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
-WORK TO HOUSE SEWER @ $1.00
JHRIERMSA�6 SBIF�S N SE $1.00 STATE ENCROACHMENT
eA
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS' PERMT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION 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.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK'
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND- STATE THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY CESSPOOL❑. DRYWELL
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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWAER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 11r
SIGNATURE l�L!/ SEEP. P1T(S) ❑ CESSPOOLS❑ /Z-2b'b - e--------=
OF PERMITTE
®r, VAUDATIO •ROBERT A.WOOD
a.*., IWO SUPERVISING MECHANICAL ENGINEER