HomeMy Public PortalAbout9802 LA ROSA DR_Sewer__ DEPART74ENT OF COUNTY ENGINEER
SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PERMIT APPLICATION
WILLIAM J. FOX, COUNTY ENGINEER BUILDING p
ADDRESS JE _
ppo A I A R Os,JFOR APPLICA. TnTO FI LFl L IBUILDING r r r LOCALITY t A SERIAL NO. PERMIT NO.
NEAREST
�Z�9CROSS ST. Reedy far lnp.ction . DATE ISSUED
OWNERMAIL OCCUPANCY BK MAP PG
u
ADDRESS
el
CITY TELNO.,v p &d, 77
CONTFEACT02 62,p r ` 'r f7 L( rJ CO.IMP.N0.
ADO REBS1 (f 30B.NO.
�e 4
CITY A J.. L �� 3jEL.NO. fy�s; ��� TRUNK PERMIT NO.
,.J [,�<STATE y
REGISTRATION N /rs /J'��s� y /'�//'i�LJ COUNTY ROAD PERMIT N0.
LEGAL OT - r STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT 9 l INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOTS.
ON LOT
CHARGES
USE OF CONNECTION CHARGE FEE
BUILDINGS NOW
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER C $ 3.50 ,S"O RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING I DATE 'IBY
SEWEROR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA.
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR-0RAINFIELD 2.00 STATION _ DEPTH
CESSPOOL—DRVWELL
SPECIAL CONDITIONS ONLY 2.00t��,C MANHOLE REFERENCE
J /!� UPPER IAKER'
TYPE OF CONNECTION LEN C.TN FROM y fir/
aY: CURB JW.: M.L.TO P.L. aS N
OWNERS PERMIT ; I W
AUTHORIZATION ' TOTAL FEE I j� 5i
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING; APPROVALS INSPECTOR'SSiGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....&_L_..DA OF... ____19� NEW HOUSE SEWER --I{ , I(M . IQ�;
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT�p_... _�t.V.:'4:L ®�......_.__......_I
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.. ._.._......_.._..._._. AND/OR 0RAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] DRYWELLC]
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
sCALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
s DESCRIH D RESIDEN{TI $ PROPERTY. BACKFILL SEPTIC TANKS Q /^L fµ1 �
AND STATE OF
ER OF THE ABOVE 1 SEEP.PIT(S)0 CESSPOOLS 0 CiLl ,w I
SIGNATURE PITTEE r�'� ... ------------
76&642A
-1/----
OF PERMITTEE .. .
Y6A642A 663 17/53