HomeMy Public PortalAbout9815 LA ROSA DR_Sewer__ D
CROOS a-ao APPLICATIO FOR PER IT
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COUNTY of LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUDDING AND SAFETY DMSION Bul LDING
ADORESS
CLO
A. LAMBIE. County En air
t CASSATT D. GRIFFIN. Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL
N. caoss ST.
LEGAL
DESCRIPTION LOT N0. I ' OWNERBLOCK TRACT TRACT S/ MAIL
o ADDRESS
NO.OF BLDG$. t�
SIZE OF LOT NOW ON LOT CITY TEL. NO. C/
USE OF
BUILDINGS DISTRICT NO.I GROUP I
BK PG MAP I PROC{ASSED BY
CONTRACTOR /I' /
ADDRESS — - CONNECTION DATA
CITY 04. TEL.NO. �.. STATION DEPTH
STATE MANHOLE REFERENCE UPPER
[OWNER
ISTRATION NO. �. I'` B COUNTY ,� ry
DESCRIPTION OF WORK FE X42
PUBLIC SEWER CONNECTING TO �� sb.00 ..,//
(`L� TYP CONN I / LENGTH FROMC
SEPTIC TANK,SEEPAGE PIT OR Y. U .L M.L.TO P.L.
PITS AND/OR DRAINFIELD S ,00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.. CESSPOOL. DRYWEL L @ $1,00
HOUSE SEWER CONNECTING TO P-C.NO.
PRIVATE DISPOSAL SYSTEM @ S1.00 CO.IMP. N0. �, JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. SL
WORK C HOUSE SEWER $ .00
A ITER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
EWER OR DISPOSAL SYSTEM @ .00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
MORIZATION TOTAL FEE REIMBURSEMENT FEE
VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
CTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE, INSPECTOR'S SIGNAThRE
HE PUBLIC SEWER.
NED THIS DAY OF�I9_ NEW HOUSE SEWER /3Y. F?Zr
A •��V CONNECT ADDITIONAL
OWNERS AGENT BUILDING D WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [IDRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR.SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF pgAN DON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI OPERTY. ✓ SEEP.FPIT( EP❑ CAN POOLS
SIGNATURE
OF PERMITTE
®• VALR)ATIO ROBERT A. WOOD
06 Y.o, cAZB
SUPERVISING MECHANICArL�ENGINEER
'°A°AE°
CE808 8-69 APPLICA ION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION Bull DING
ADDRESS Z
IOIN'1 A. LAMBIE, County Enyinppr
CASSATT D. GRIFFIN, Supt pl Buildi., LOCALITY
FOR APPLICANT TO FILA. IN CROSS ST. / .!
LEGAL
DESCRIPTION LOT N0. OWNER e-`/
BLOCK TRACT �� u''/ MAIL
ADDRESS
NO.OF BLOCS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS y` DISTRICT N0. GROUP MAP/. _ER0,CESSED BY
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL.NQ ® STATION DEPTH -
/'�! C STATE MANHOLE REFERENCE _ UPPER
REGISTRATION N0. _ I;r ❑ COUNTY I
NO. 1 DESCRIPTION 01, WURK
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ 3.00 TYPE 0 NNECT /� LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CY B / ,L M.L.TO P.L.
PRS ANO(00.0RAlNFIELO @ 3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.. CESSPOOL.DRYWELL @ 2.00
HOUSE SEWER CONNECTING TO P.B NO-
PRIVATE
-
PRIVATE DISPOSAL SYSTEM @ .00 CO.IMP. NO. ) JOB N0..
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. - ROAD PERMIT NO. (-
WORK TO HOUSE SEWER @ 1.00
ALTER, REPAIR OR ABANDON HO STATE ENCROACHMENT '
SEWER OR DISPOSAL BYST J@ .00 PERMIT NO.
_ rINDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S 1PERMT $ CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE 6-V REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR �1�� CONNECT ADDITIONAL
OWNERS AGENT /' �, ///!/l•����✓✓ BUILDING OR WORK
T '
ADDRESS- SEPTIC TANK,SEEP.PIT(5)
AND/ORORAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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 pLTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND OR DISCONNECT PLUG AND
THAT
LICENSED AS RE BY LO ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 HE LEGAL OWNER OF THX ABOVE
DESCRIBED RESIDENTIAL RTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE
SEEP. T(S ❑ CESSPOD S ❑
OF PERMITTE
®r VALIDATION ROBERT A. WOOD
K,
CH.0. t SUPERVISING.MECHANICAL ENGINEER
8 0 1 1 APP, 3 0 1 1 D 2 5 .0 0