HomeMy Public PortalAbout9824 LA ROSA DR_Sewer__ 'aAe""
ceaoe.e-Be APPLICATION FOR PERMIT (T
COUNTY OF LOS ANGELES1
DEPARTMENT OF COUNTY ENGINEER
SEWER—SEWAGE DISPOSAL +
BUILDING AND SAFETY DIVISION ADDRESSMNO. .-
USE
JOHN A. LAMIE, County Engine.. ADDRESS CASSATT D. GEMM, Sup t of Building LOCALITYFOR APPLICANTTOFILLLN NEARESTCROSS ST.LEGAL �/DESCRIPTION LOT N0. OWMAINER.MAIL
BLOCK TRACT � LADDRESSNO. OF BLDGS.SIZE OF LOT NOW ON LOT CITY OF
BUILDINGS .��� DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
-
CONTRACTOR
ADDRESS CON ECTION DATA /
CITY TEL. NOZ9CI Al - OEIZ 24 2, DEPTH
STATE ✓ `i_
REGISTRATION NO. � / � 9 ® COUNTY MANHOLE REFERENCE/h C
No. DESCRIP ON OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 2 V O
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELO @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, GRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MAN HO LE @ $2.00
HOUSE SEWER CONNECTING TOP. C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. 3D JOB N0.
CO N
WORK C HOUSE ADDITIONAL
SEWELDG. OR @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. i
SALTER, REPAIR OR ABANDON EWER OR DISTATE ENCROACHMENT
DISPOSAL SYSTEM HOUSE @ $1 00
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERSP6RbUT W
S 2 0,0` CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. 'APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING-
TO THE PUBLIC SEWER.
SIGNED THISIy_ NEW HOUSE SEWER
OWNER OR . npY OF CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PITS) -
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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE "LEGAL OWNER OF THE ABOVE-
DESCRIBED RESIDE TI PROPERTY. BACKFILL SEPTIC TANKS El
SIGNATURE S .PIT(S) ❑ CESSPOOLS
OF PERMITTE 1 _
®e VALM.0. sH ROB MECCA WOO
'
CK. B.o. cAsx ' SUPERVISING MECHANICAL ENGINEER
LAV".5 6.6 D ; 41110 6 g J" p . 5.0C
TEMPLE CITY
>epe�:D . �`l• APPLICATION FOR PERMIT
teeae a-ae
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING S
ADDRESS
]SSA A. LAMIE,GRIFFI , Suprt of uildi
CASSATT D. GRIFFIN. Suet of Building LOCALITY
NEAREST
FOR APPLICANT TO FEL IN CROSS ST. ztxe�10
LEGAL J 6
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
O/� N0.OF BLDGS.
SIZE OF LOT 2� /G!. ! NOW ON LOT CITY TEL. N0.
USE OF
If
DISTRICT NO. GROUP MAP / I PROCESgp BY
/. BK PG
CONTRACTOR SF 0 T r K tom"
ADDRESS U CONNECTIO DATA
CITY TE L.NO. O GJ DEPTH
p� /�' STATE MANHOLE REFERENCE/ �- /
REGISTRATION NO. -/ fl � -/ ® COUNTY / J� /'
OWER".
NO DESCRIPTION OF WORK F E
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. C RB P.L. M.L. 0 P.L.
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD 2
E%TN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO JOB NO.
CONNECT O SE SEWER
BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0. . }
WORK C HOUSE SEWER @ $1.00
A LTEN, RE PAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL YS EM @ $1.00 PERMIT NO.
INDUSTRIAL -
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ ICOMPLY
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ✓Z� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREICON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGLLING APPROVALS GATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF _ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT eA�/ /� BUI LDING OR WORK
ADDRESS SEPTIC TANK,SEEP. PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIATION
ANp STATE THAT THE ABOVE IS CORRECT AND AGRMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATELAWATING pLTER,REPAIR,BEWER OR
PLUMBING AND SEWERS. SEWAGE EPAIR,SEDISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISND/OR ONNECT PLUG ANO
LICENSED AS REOUIRED BY l05 ANGELES COUNTY TE OF pBANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER ABOVE
DESCRIBED RESIDENT PROPERTY. BACKFILL SEPTIC TANKS Cl
SIGNATURE SEEP.PITS) ❑ CESSPOOLS
OF PERMITTEE
®r VALT0{q'IO ROBERT WOOD
_ CK. M..o, cAstl SUPERVISING MECHANIGL ENGINEER
O 5 6 6 1 S (IVIG '-6 1 1 p �D
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