HomeMy Public PortalAbout9818 LA ROSA DR_Sewer__ o
cEao8 APPLICATION FOR PERMIT
aaoa a-sa - CQVNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
C SEDADAIalE, Si
oADDRESS
44
ATP . GRIFFIN, ; IPlgjdiq
LOCALITY
NEAREST
FOR APPLICANT TO FRI IN c..S, ST.
LEGAL .OWNER
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE DI DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS BK PG
CONTRACTO 0 .
ADDRESS G ' cr CONNECTION DATA -Y
CITY 6 TEL.N0. I DEPTH
/ STATE M4NNbLE REFERENC !_ UPPER
REGISTRATION NO. L
NO. I DESCRIPTIO OF WO FEE / 2Q
HOUSE SEWER CONNECTING TO C/ LY�K.
PUBLIC SEWER @ $3.00 9
SEPTIC TANK.SEEPAGE PIT OR TYPE.OF CONNE LENGTH FROM 2 a
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. - M.L.TO P.L. c7
OVERFLOW SEEPAGE PIT. DRAINFIELD -
EXTN..CESSPOOI DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO r 6 S JOB NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N
WORK TOTHOUSEISEWEBLDG.OR @ S1 00 TRUNK PERMIT N0. - ROAD PERMIT NO. l fila/ qd
SEWER OR DAISPOR ABANDON OSAL SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL '
CHARGES
OWNERS PERMIT s 2 DD CONNECTION CHARGE FEE
AUTHORIZATION I 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. I I F7 r Lr
SIGNED THIS DA 1D— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESzfzS- SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM P PERLY REGI RE A /OR DISCONNECT PLUG AND
LICENSED AS UIRED BY A GELES C T AND T E OF
CALIFORNI 1 T E L GAL NE A H ABOVE ABANDON HOUSE SEWER
DESCRIBE RESIDENTI P OP T BACKFILL SEPTIC TANKS ❑
SIGNATOR
SEEP PIT(S) ❑ CESSPOOLS ❑
OF PERMI
®' ALIDATION ROBERT A. WOOD
M.o, CASH SUPERVISING MECHANICAL ENGINEER
CILR
I ^o0657� MAY 111 0 A 5.00 m
E80
c8aea APPLICATION FOR PERMIT
ceoe a COTMTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
ADDRESS
rrOHII A. LAMBIE, County. Engine.,
CASSATT D. GRIFFIN. Sup t o4 Building LOCALITY
NEAREST
FOR APPLIC T TO FILL IN CROSS ST. i
LEGAL I OWNER �•—��
DESCRIPTION LOT N0.
�
BLOCK TRACT NAIL ADDRESS
N0.OF BLDGS.
SIZE OF LOT HOW ON LOT CITY *W571UZ�TEL. N0.
USE OFDISTRICT N0. GROUP MAP PROCESSED BY
BUILDINGS !V� I BK_
/ E PG
CONTRACTOR
L
ADDRESS CONNECTION DATA
ITY L.N0. e14 or T DEPTH
)•y `7 STATE AN OLE RE ERENCUPPE
E
EGISTRATION N0. Y/ � ER
0. 1 DESCRIPTION OF_VVORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CON LENGTH FROM PITS AND/OR EPTIC �RAINFGELDT OR $3.00 Y. CURB P.L. M.L.TO P.L. D
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESS POOL DRYWELL @ 42.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM 41.00 CO.IMP. 0. JOB NO.
WORCONNECT K TO HOUSEISEWONAER BLDG.OR @ $1 00 TRUNK PERMIT N0. ROAD PERMIT NO. �5I
SEWER, REPAIR OR
ASPS TE M NOUSE @ $I00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
C d� CHARGES
OWNEItS I PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATIONI TOTAL FEE REIMBURSEMENT FEE
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGDATE A CONTRACT WITH THE HEREINAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY 019_ NEW HOOSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS.AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
/
ADDRESS AND/OR DRAINFIELD
I HEREBY ACK LEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY TNA I OPENLY RE STERED ND/ R DISCONNECT PLUG AND
LI CEN QUIRE D AN El COUN AND AT OF ABANDON HOUSE SEWER
CALL RNIA OR AT AM HE E L .OWN OF T E AB VE
DES RIBED RESIDE I PR RTY BACKFILL SEPTIC TANKS ❑
SIGNATURE_
SE;;.PIT(S) SPOOLS O
OF PER
®F ALIDATION ROBERT A. WOOD
CK M.o, cAstl SUPERVISING MECHANICAL ENGINEER
IAr60
' 0658S MAY11 1 1 A 25.00