HomeMy Public PortalAbout9521 LA ROSA DR_Sewer__ D
IS E-663 11.35 APPLICATION FOR PERMIT 1
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DIVISION OF• BUILDING AND SAFETY SEWER_ SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING,
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS _L�/ R �• .-QJ
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY a
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL
DESCRIPTION LOT NO./x / OWNER -
MAIL
BLOCK TRACT IyO ADORES
NO. OF BLDGS. CITY TEL. N0. �l / �J
SIZE OF LOT NOW ON LOT r •7 �+ �LJ
USE OF __// DISTRICT N0: GROUP
MAP
BUILDINGS .�`•� (�
r /BK PG
CONTRACTOR L L' - O
ADDRESS _ CONNECTION DATA
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CITY - L. NO. STATION 7� DEPTH
�.Q MANHOLE REFERENCE UPPER
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El STATE
REGISTRATION NO. /-/ •4 13•- (rte.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM
Y. UR P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50 C3 J n
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD PC.CO. IMP. NO. f L� j JOB N o
EXTN.;CESSPOOL,DRYWELL,MANHOLE Q $2.00
HOUSE SEWER CONNECTING TO f—��
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT N0. ROAD PERMIT N0. ,
'CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE •
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDcoN- APPROVALS DATE INSPECTOR'•SSIG ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. I NEW HOUSE SEWER
SIGNED TH15 DAY OF 19s— CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS ./L/, AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW ER
CALIFORNIA. OR THAT I AM- THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPER BACKFILL SEPTIC TANKS❑
SIGNATURE
•I SEEP.PIT(S) ❑ CESSPOOLS 7
OF PERMITTEE
JOHN A. LAMBIE.COUNTY GINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
m 0. CASH - -
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