HomeMy Public PortalAbout9822 LA ROSA DR_Sewer__ ��/✓� �� .E � i �� /viosr h/��R�Y
'°"°°= APPLICATION FOR PERMIT ���
CE008.8.88
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL .
DEPARTMENT OF COUNTY ENGINEER
BUELDING AND SAFETY DMSION emLmeG
TORN A. LAMBIE, County Engine°:
CASSATT D. GRIFFIN. Supt of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS Sr. lyr
LEGAL. - - -
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
SIZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NOJ GROUP I MAP - PROCESSEpq.BY'
BK PG
CONTRACTOR ff e .
ADDRESS "'� 5" - CONNECTION ATA H/' -
CITY TEL. N0. (&eAl 6, ION DEPTH
® STATE -
REGISTRATION N0. MANHOLE R FERENCE
COUNTY OWER
N0. DESCRIPTION OF WORK FEE _
/ HOUSE SEWER CONNECTING TO -
I PUBLIC SEWER @ S3.00 TYPE OECONNECTION LENGTH FROM -
SEPTIC TANK, SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
.PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN„CESSPOOL,DRYWELL,MANHOLE @ 52.00 h
HOUSE SEWER CONNECTING TO ,/ -P. C. NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO.-IMP. N0. J✓ J0B NO.
CONNECT ADDITIONAL BLDG.-OR TRUNK PERMIT NO. - ROAD PERMIT NO. -4I-D
WORK TO HOUSE SEWER @ $1.00
ALTER. REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION FTOTAL FEE 0-2> REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS GATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. /��/ P../
SIGNED THIS DAY OF 79_ NEW HOUSE SEWER %"' �I,7 /'xl'It/di YGt'7.-
OWNER OR .. / CONNECT ADDITIONAL .
OWNERS AGENT10!�2q X��'✓ BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENYAV PROPERTY, BACKFILL SEPTIC TANKS❑ _
SIGNATURE SEE '.*IT(S) [ICESSPOOLS El.
OF PERMITTE
®. VALIDATION ROSERTA.WOOD
CK. Y,0. CKR SUPERVISING MECHANICAL ENGINEER
ll1G:)`= ua ,wc ?610 SE� O . W
TEPAPLE COTY
CE808 . APPLICATION FOR PERMITI�
CE808 B�tIB 7
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �, D -A
ADDRESS
I SA A. CARAFE, County. of Bueer
CASAAIT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT 'NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO.
GR-DrUUP MAPPG PROCESSEQ'BY
CONTRACTOR '510 / BK w
ADDRESS ! '� A_ _Y CONNECTION DATA
CITY TEL.NO.L L/L/!jo ON IO
DEPTH
�J/� ❑ STATE MANHOLE REFERENCE
REGISTRATN N0. c/ ry ❑ COUNTY LO ER
No. UEC
RI PTI NOF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM 7"' /
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ 83,00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P,C.NO.
PRIVATE DISPOSAL SYSTEM @ 51.00 CO.IMP. NO. ) JOR N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N . ROAD PERMIT ND.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM S1,00 PERMIT NO.
C INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 0-0 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.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER ORA �^ CONNECT ADDITIONAL
OWNERS AGENT ' �✓1/ BUILDING OR 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 ❑ DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE REPAIR,
SEWERDISPOSAL EM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIa PROPERTY. BAC FILL SEPTIC TANKS ❑
SIGNATURE
SE PITS ❑ CESSPOOLS
OF PERMITTEE
®' VALIDATION ROBERT A. WOOD
._ CX. M.B. CASB SUPERVISING MECHANICAL. ENGINEER
1U^o 5 6 6 3 5 AU122 6 1 1 D 2 5.0 0