HomeMy Public PortalAbout9828 LA ROSA DR_Sewer__ CEBOBO-61 APPLICA ON FOR P - MIT
CEBOS 3
COUNTY OF LOS ANGELES SEWS` -SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU ao1nG �. �g
ADDRESS
JOHN A. LAMIBIE, Couatp En inset !
WILLIAM] A• ]ENSEN, SuP't oI Building_ LOCALITY
NEAREST
J. marlda-
FOR APPA TO FIIL IIV CROSS ST.
LE AL
DESCRIPTION LOT NO OWNER
BLOCK TRACT / MAIL
ADDRESS
N0.OF BLOTS. _ / O✓
SIZE OF LOT NOW ON LOT CITY //�/ F TEL. NO -
USE OF
BUILDINGS DISTRICT NO. GROUy� MAP PROCESSED BY
�. ///J/ K PG
CONTRACTOR 1_146_�pva )01
'Q J. G I
ADDRESS -3 � ��� CONNECTION DATA
CITY (fa T Q� STATIONi�7 DEPTH
REGISTRATION NO. O 2 B COUNTY ATE STATE MANHOLE REFERENCE �O� /
l/ N / LOWER'
NO. DESCRIPTION OF FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $S.00 PE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EATN. CESSPOOL.DRTWELL @ f2.00 1
HOUSE SEWER CONNECTING TO P.C.N0. O
PRIVATE DISPOSAL SYSTEM @ f1.00 CO.IMP. NO.. 3 0,5' JOB N0. V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0. Z
WORK TO HOUSE SEWER 51.00
SEVIEP OR DASPOSAL SYSTEM MOUSE @ $1.00 STATE ENCROACHMENT Q
PERMIT NO. V
INDUSTRIAL W
d
WASTE APPROVAL N
c. CHARGES ?
OWNWS PERMIT S 2 00 CONNECTION CHARGE FEE
AUMOMATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPAOVAIS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 1B— NEW HOUSE SEW ER�C.f/ /X— _ �µ.ia...
OWNER OR ^ CONNECT ADDITIONAL
OWNERS AGENT ( 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 ❑ DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEW
I HEREBY CE Y AT I AM PROPERLY REGIST ED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS OUIR BY LOS ANGEL LINTY D STATE OF DISCONNECT PLUG AND
CALIFORNIA TH 1 AM THE
LE MINER F THE ABOYE ABANDON MOUSE SEWER
DESCRIBED SID AL PROPERTY. BACKFILL SEPTIC TANKS ❑
SEEP.
SIGNATUP PIT(S ❑ CESSPOOLS
OF PERMI
VALIDATIgP1----1 ROBERT A WOOD
cs M.o. wtl SUPERVISING MECHANICAL ENGINEER
_ •
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DEC 7 1 0 D 5.0 0 n