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HomeMy Public PortalAbout9587 LA ROSA DR_Sewer__ nErAxTBIENT of comvTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES - WILLIAM J. FOX, COUNTY ENGINEER I BUIADLDING ORESS TO/ FOR APPLICANT TO FI IN LOCALITY BUILDING �//7 ///? �Q_ NEAREST AOD RESS OO / /L r,lC�! /T GROSS ST.. LOCALITY / sV L'�/119217e DISTRICT NO. SERIAL=0. PERMIf O_ NEAREST �[% /� af"^ ArAafj 7 7 CROSS ST. Y �� C�' `L^1'� - RREE�CEIVE0 BY ReadY for Inspection DAT ISSUW OWNER /✓ J 7L•T" ' ' MAIL �/� / A . f:� USEZONEV OCCUPANCY �B PG ADDRESS l v-'fl' }" �J /' �j CITY✓`-G�� , ./ ao`— IL / �G.hJ- y` O CONTRALTO ,�s/2/}! WIMP 0 ADDRESS` !� ,(}`� ��( ) JOB NO. 7Sci' G CITY e4jo 1/T TEL.NO. �1 T /J� TRUNK PERMIT NO. _ ( �/ �7 REGISTRATION NO. + COUNTY ROAD PERMIT N0. ZS.S ell DESCRIPTION LOT N0. aY //�Q LEGL STATE ENCROACHMENT PERMIT NO. BLOCK TRACT .�.� -,4 Z— INDUSTRIAL /s / WASTE APPROVAL SIZE OF LOT J NO.OF BLOTS. / CHARGES NOW ON LOT USE DI • '/ /��� CONNECTION CHARGE FEE OF A / BUILDINGS ,,((�� NO. DES RIFTION OF WORK FEE HOUSE SEWER CONNECTING TO _ REIMBURSEMENT FEE � CE/UT G ' PUBLICSEWER @6 3.50 �� RECEIPT NO. I D TE IBY Q FI 1= HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR (CEPTION REC DED WORK TO HOUSE SEWER - 1.00 DATE BY ALTER OR REPAIR EXISTING _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.60 I CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR / PITS AND/OR GRAINFIELD 2.00 STATION �/O © FFF � DEPTH ESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 .0 ANHOLE REFERENCE LOWER YPEOF CONNECTION LENGTH FROM r OWNERS PERMIT j /'I 00 Y. -e:b M.L.TO P.L. AUTHORIZATION TOTAL FEE 41 _,Tv IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE/PUBLIC SEWER SIGNED THIS._. f . QDAY OF.....__"..._. -rf 19 � NEW HOUSE SEWER �G Y'o O� 1.4'/q OWNER J DIN ADDITIONAL OWNERS AGENT` ��. .G.:v_Vl_ `•�C,c{_C� _ BUILDING OR WORK CON �� G _ �/ SEPTIC TANK.SEEP.PIT(S) ADDRESS_......... _.... ._................ ..:.�_ AND/OR DRAT NFIELD 1 HEREBY ACKNOWLEDGE THAT 1 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 ABANDON HOUSE SEWER AND STATE OF CALIFOR A OR THAT I AM THE L GAL OWN• —' ER OF THE A80V/E DfL`SC IS ESIDENTIA P ERTY. BACKFILL SEPTIC TANKSCj f � SEEP.PIT(S)E] CESSPOOLS SIGNATURE 'L_2 ��. •�eJ" OF PERMITTEE..._....... .. .___...".- .._.._.._.._.._.._------_-- 76AG42A 663 7/53