HomeMy Public PortalAbout9820 LA ROSA DR_Sewer__ DEPARTDffi9T OF COUNTY ENGfNE= SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES �
WILLIAM J. FOX, COUNTY ENGINEER A UILDIN I BUILDING
FO ,APPLI NT Jq( FILL 114 LOCALITY
BUILDING // �j// NEAREST \( /
ADDRESS004``��� 1G ��/(((LL4TL�iii NEAREST.
LOCALITY DISTRICT NO. Ready for Inspection PERMIT NO.
NEAREST .5 e� c
CROSS ST.
RECEIVED4 ` A T IS I-e-
`
DATE
OWNER �l O`
MAIL
ADDRESS USE ZONE OCCUPANCY -MAPS
CITY TEL-WO.
CONTRACTOR
CO.IMP.N0. U
ADORES6� 0
JOB.N0.
CIT L.NO
TRUNK PERMIT N0.
REGISTRATION NO. 0 COUNTY
ROAD PERMIT N0.
LEGALr / ,'� STATE ENCROACHMENT
DESCRIPTION LOT NO v
PERMIT NO.
BLOCK TRACT52 �� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT O XI/�1 D NOW ON LOTS CHARGES
USE OF
BUILDINGS //��Q yy� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
-PUBLICSEWER a $ 5.50 RECEIPT N0. I D E BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION ECORDED
_ WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING NO' I DATE BY
_ SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER -
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR -
_.PITS.AND/OR GRAINFIELD 2.00 STATION ¢'f" DEPTH 7
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ',33 O ` MAN(HPPIEREFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM O
OWNERS
Y.` --P.6. M.L.TO P.L. r�
PERMIT ; I 00 -,
AUTHORIZATION _ TOTAL FEE Jf'
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORI§SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER �/ /n
SIGNED THIS.._.—_DAY OF—_ __19_ NEW HOUSE SEWER 7�.t�Q „ d
CONNECT ADDITIONAL --
OWNER OR /�if-� BUILDINGORWORK
OWNERS AGENT..........._..
SEPTIC TANK,SEEP,PIT(S)
ADDRESS---------------.._.._------_......._..__.__._.._.._.._.._.__......------...._. AMD/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL Q DRYWELL
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUN Y ABANDON NO PLUG AND
ANO STATE OF CALIFORNIA Ofl THAT 1 AM THE LEGAL 0 N-
ER OF THE ABOVE CRIBED RE NTIA PROPERTY BACKFILL SEPTI C TAN KSS
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
OF PERMITTEE
76A642O S&E GG3 4/54
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2"D
76A 6AZD APPLICATION FOR PERMIT
JfiA
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILD.NG "
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING v
LOCALITY
FOR APPLICANT TO FILL—IN NEAREST
CROSS 6T.
!PRINT OR TYPE ONLY?
EGAD ,/ 4/
DESCRIPTION LOT NO. /� i)!' OWNER
/L r`• MAIL
BLOCK TRACT 9p Lf ADDRESS C"
L NO. OF BLDGS. V Z
SIZE OF LOT (djO NOW ON LOT CITY TEL. NO.
USE OF
BUILD.NG6 DISTRICT N0. GROUP ILA. MAP PROCESSED By
ps
� / B K
CONTRACTOR �� I/L� �+ +V F/ J /�
{/ I ate✓
ADDRESS CONNECTION DATA
CITY TEL, NO. STATION DEPTH
STATE LICUPPER
LICENSE NO.. CLAgg M4NXOLE REFERENCE
LOWER
NO. .DESCRIPTION OF WORK FEE TYPEOF CON TION LENGTH FROM
HOUSE'SEW ER CO NNECTING TO Y. CURB p.L M.L.TO P.L.
PUBLIC SEWER (10 SS.00 NO.
SEPTIC TANK.SEEPAGE PIT OR
PITS ANO/OR ORMIRFIEL. @ 510.00 CO.IMP. NO. J.QB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT\`
CONNECT ADDITIONAL +� AFFIDAVIT AIY 12[NEX RE CORD. INSTR.NO. �- DATE O
WORK TO HOUSE SEWER @ 53.00 JY V
OVERFLOW SEEPAGE PIT.DRAINFIELD
EATN..CESSPOOL.DRYWELL.MANHOLE @ $5.00
ALTER.REPAIR OR ABANDON HOUSE HWY,OR ST,WIDENING O
_SEWER OR DISPOSAL SYSTEM ® $3.00 STATE u
PERMITENCROACHMENT )
PERMIT NO. �( / W
INDUSTRIAL / Z
WASTE APPRO VAL � �
CHARGES
OV✓NER'S PERMIT 5 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS DAY OF 19
OWNER OR - NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL L
ADDRESS BUILDING OR WORK
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIGATI ON SEPTIC TANKANO�OR DRAT SEEP,1111S)
NFIELD
AND STATE THAT THE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORD.IRANANCEE S AND STATE LAWS REGULATING ❑
PLUMBING AND SEWS S. CESSPOOL ❑ ORYW ELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR
LICE
NSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG ANO
RESIDE IN, THE ABOVE DESCRIBED RE51 NTIAL PROPERTY. ABANDON HOUSESEWER
SIGNATURE
OF PERMTTE BACKFILL SEPTIC TANKS ❑
SEEP,PIT ISI ❑ CESSPOOLS ❑
VALIDATION JACK R. ALLEN
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
J
jlCo G y MAY X 1 0 0 6.00-