HomeMy Public PortalAbout9816 LA ROSA DR_Sewer__ '°"°" APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
ORN A. LAMBTE, C S.ty E six N
C YI' D. GRIFFIN, Svy 1 eff d" LOCALITY U.
NEAREST
FOR APPLICgANT TO FILL IN caoss sr. --
LEGAL / OWNER
DESCRIPTION LOT NO.
BLOCK TRACT l,` MAIL
ADDRESS
N0,OF BLDG$. "
SIZE OF LOT NOW ON LOT CITY EL. NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY
CONTRACTOR
ADDRESS — CONNECTION DATA
CITY TEL.NO. DEPTX S
REGISTRATION NO. ? 7_ E MA HOLE REFERENCE UPPER
'`TAT
No. DESCRIPTIO 0 WORK FEE r
HOUSE SEWER CONNECTING TO G � FL'7�•/^/'
PUBLIC SEWER @ $3.00 Q!1
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNE LENGTH FROM
/+
PITS ANO/OR DRAINFIELD @ $3,00 Y. CURB' .L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00 SY
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $LOO CO.IMP. 0. JOB NO.
WORK TO OUSESEWER
CONNECT ADDITIONAL
IBLDG.OR @ $I 00 TRUNK PERMIT NO. ROAD PERMIT N0. I70� y
SEWER OR DISPOSAABANDON L SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE p REIMBURSEMENT FEE
I 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. p _
SIGNED THIS D Y OF 19_ NEW HOUSE SEWER 13'L
OWNER OR CON NECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP. PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT_AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
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 RE R AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS NGELES COU A S TE OF ABANDON HOU SE SEWER
CALIFOft THAT T LEG OW R TH ABOVE
DESCRI D REST NTIA P P T SEEPFILL SEP IC TANKSCESSPOOLS0 ❑
SIGNAT RE f
OF PE ITTE
®" s V)ALIDA,TION ROBERT A. WOOD
Y.°. GSR SUPERVISING MECHANICAL ENGINEER
LACoo 6s 5 A 5.00
&aO:2D
CAPPLICATION FOR PERMIT
saoa ae> COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL-
DEPARTMENT OF COUNTY ENGINEER
-BUILDING AND SAFETY DIVISION BUILDING -
-' ADDRESS
'OH IT A. LAMBIE, County Ea veer
CASSAlt b. GRIFFIN. Supt-of Building LOCALITY ^'
NEAREST
FOR APPLICANT TO /FILL IN CRDs, ST.
LEGAL
DESCRIPTION LOT NO. / OWNER Z
MAI L
BLOCK TRACT Gr .v ADDRESS -
ANO.OF BLOCS. '
SIZE OF LOT NOW ON LOT CITY L. NO.
USE OF DISTRICT N0. GROUP MAP I PROCESSED BY
BUILDINGS _ gg
CONTRACTOR PG
//_'
ADORES, CONNECTION DATA
CITY TEL.NO. 6 T DEPTH
REGISTRATION N0. N OLE RE RENCE UPPER
� / `���/
No.e DESCRIPTION F 0 R FEE
'L HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONREET101 LENGTH FROMSEPTIC TANK,
-
PITS AND/OR DRAINFGELDT OR @ $3.00 Y. CURB P.L. M.L.TO P.L-.'"
OVERFLOW SEEPAGE PIT,DRAINFIELD -
EKTN„CESSPOOL. DRYWELL @ 52.00
PRIVATE DISPOSAL SYSTEM SE SEWER CONNECTING TO @ $1.00 CO.IMP. 0. - P.C. O. -
r . .IDB NO. (
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. /4/;X
WORK TO HOUSE SEWER @ SI.00
A LTER,RE PAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR D ISPOSA L SYSTEM @ $1.00 PERMIT NO.
-010 INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ ;-- CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEEQFC REIMBURSEMENT TEE
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 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC'TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION J
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,,EWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGI D D/OR - -
LICENSED AS REQUIRED B 0 GELES- OVNTY AN ATE OF DISCONNECT PLUG AND
CAL OR THAT M E LEG OWNE OF E BOVE ABANDON HOUSE SEWER
DES RIBED R DENT[ PR RT BACKFILL SEPTIC TANKS[ISIGN URE
SEEP.PIT(S) 71CESSPOOLS ❑
OF PE TE L �
®r ALIDATION ROBERT A. WOOD
cK. M.9 GSH SUPERVISING MECHANICAL ENGINEER
LaLO � Ss� rA��v1 � 11 A 25 .00 r