HomeMy Public PortalAbout9805 LA ROSA DR_Sewer__ DEFARThffiSIT OF COUNTY ENOINEM SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER I BUILDING F/0 +r 1V
ADORES$ 6/
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FOR
AAPPPLICANT TO77/6,�7] CROSS
LOCALITY, tf.�..3j.,).
ADDRBUILDESS %Fl>/.L JNEA5T. �/'�.. �^1't'"+
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LOCA LITY� DISTRICT N0. Ready for Insoeetlon PERMIT-N0.
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NEAREST.-
CROSSST- -
_ RECEIVED Y DATE j4 ISSUED BY �� DATE
OWNER ,tfl/.•i.l 1r / d hA. N+:'eC+l"4f.'r -w£�l'uhi C X43 a
MAIL USE
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ADDRESS ZONE OCCUPANCY �K PPB
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CONTRACTOR / jI//i/7i» /!9/i/ l.7 LO
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ADDREBl�/j.;tl,��L ,rfn•/i7iTi1.• /.ys-r. JOB.NO.
CITY eJf'' TELAO. f ..
�F //' '"!/�!{i ,//a// Cr-�}� 3� TRUNK PERMIT NO.STATE
REGISTRATION N0. /�)rJ�;/G.�/'J ❑ COUNTY ROAD PERMIT NO.LEGAL j f
DESCRIPTION LOT NO.t_ 9.��C1 �..J STATE ENCROACHMENT - -
G PERMIT NO.
BLOCK TRACT /�8� INDUSTRIAL ....�...+.•..w.,.,;, -..+ _
WASTE APPROVAL
S12E OF LOT _ NO.OF SLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHA_RGEFEE f NO. DESCRIPTION OF WORK FEE - -
HOUSE SEWER CONNECTING TO , REIMBURSEMENT FEEr,_
PUBLIC SEWER a 8 3.50 L __ RECEIPT NO. I DATE IBY
ROUUSESE
SEWER CONNECTING TO � -
r PRIVATE DISPOSAL SYSTEM 1.00
.CONNECT ADDITIONAL BLDG.OR - EXCEPTIO N�fl ECO ROED -
` WORKTO-HOUSE SEWER -.I.00 -.
NO
ALTER OR REPAIR EXISTING - ' I`
DATE BY
SEWER
-
SEWERORDISPOSALSYSTEM 1.00 L
DISCONNECT AND ABANDON SEWER
AND/ORDISPOSALSYSTEM 1.00 CONNECTION DATA -
SEPTICTANK.SEEPAGEPITOR
PITS AND/OR GRAINFIELD 2.00 STATIONt` DEPTH l_ �
CESSPOOL—DRYWELL -
_ SPECIAL CONDITIONS ONLY 2.00 1..d,17_`✓ 7 UPPERREFERENCE
_ TYPE OF CONNECTION LENGTH FROM.Y _
-- •Yr CURB - �P.L: M.L.TO P.L. J S/
OWNERS PERMIT $ --
I`ltrt .r ,.Li�_....�.
AUTHORIZATION TOTAL FEE TI
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVEDESCRIBED'EXISTING', APPROVALS INS P ECTO SIGNATURE DATE^ ,
DWELLING TO THE PUBLIC SEWER
.,
SIGNED THIS..��/_DAY OF �^=z`-.4. 1,9 NEW HOUSE SEWER
OWNER OR - / -. f.� .✓te BUILDINGORWORK-CONNECTADDITIONpL
__ - '
OWNERS AGENT.....- . S�_/� "•� r^.:
''SEPTIC TANK.SEEP.PIT(S)
ADDRESS..._.._'��X.�.:��� .fix �lr.1l^_1�,{.f
.-....-.._.........-_.._._-_._.-...._.._....__... AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVEEREAD THIS-APPLI• CESSPOOL Q DRYWELL
CATION AND STATE TXAT'THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL'COUNTY"ORDINANCE$AND STATE LAWS ALTER, REPAIR,SEWER OR
_
REGULATING PLUMBING,AND SEWERS. ALTER, EPAIR,SEWERAL R
1 HEREBY -CERTIFY,-_THAT 1 AM PROPERLY REGISTERED SEWAGE
DISPOSGANG
M.
AND/OR LICENSED:AS:REQUIRED BY LOS ANGELES 'COUNTY PISCO NN HOUSE SEWER
AND STATE OF CALIFORNIA`OR THAT I-AM THE LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. - -BACKFILL SEPTIC TANKS Ej
SIGNATURE � g r f / SEEP.PIT(S)d CESSPOOLS[]
OF PERMITTEE.. /x /� 3 .. . .
76A642D S&E 663 4/54