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Home My Public Portal About9829 LA ROSA DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION.OF BUILDING AND SAFETY PERMIT XPPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING /J ADDRESS FOR APPLICANT TO FILL IN T� LOCALITY ADDRESS 96� _ 9831 1$ Roca ITr .• CROSS T. LOCALITY ,T 9L181e .L11t� DISTRICT NO. SERIAL NO. 7 PERMIT NO. NEAREST p ffi :.S A `�/( J CROSSST, Holden pest RECEIVED BY Ready for Inspection DA ISSU OWNERMrs. Eth@lgn R MorA&nAt L � 3�—%��,�`� ADDRESS6am8 - ' USE 7 ZONE O/CCCUPCCANCCcY BK AIAP ion CITY Same TEL.NO, At_ . 66559 // / /`c pam. CONTRACTOR . (;O=ge F=Cllenberg CO.IMP.NO. �� D J 16 ADDRESS 6522 N Golden bleat JOBNO. CITY ..fP 9ID I9 TELAO. At.; 67212 TRUNK PERMIT NO. II' T� ,�y/��p ry COUNTY ROAD PERMIT NO.LEG REGISTRATION NO. x• 5 `4 ��}',�/s� DESCRIPTION LOT NO. l® _ ALJ.^ T /� STATEE ENCROACHMENT PERMIT NO. BLOCK TRACT 9481 INDUSTRIAL [1B WASTE APPROVAL SIZE OF LOT 2G2 � '9�81®W O/N�LOTS 4 CHAR S BUEOF L DINGS_7 w9�' inpa 'A� 1IACage¢ jSE CONNECTION CHARGE FE NO. DESCRIPTION ❑F ORK FEE . REIMBURSEMENT F EE HOUSE SEWER CONNECTING TO PUBLIC SEWER @S 3.50 S©. RECEIPTNO. DATE IBY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION CORDED WORK TO HOUSE SEWER 1.00O1 N0. I DAT IBV ALTER OR REPAIR EXISTING _SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL'SYSTEM 1.00 CONNECTION DATA SE PTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION 2�.� DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 �z2,.S—/�0ANHOOLLE�REFERENCE ER TYPE OF CTI LENGTH FROM ? OWER OWNERS PERMIT' $ 00 CTR a= M.L.TO P.L. JJ AUTHORIZATION TOTAL FEE 152� CyEciC TF..'i5Y0usE.s f�i�6 I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED, rJ��/�� •f��`� V��E CONTRACTOR TO CONNECT THE ABOVE DESCRIBED Ex1sr1NG, APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER, � SIGNED THIS_'J..,�_..._DAY OF--IV, (.�.'I . .__.19,5y, NEW HOUSE SEWER OWNER OR - .� A i 14 /�(/�///J /- , CONNECT ADDITIONAL OWNERS AGENT t Y�rrL(/ UILDING OR WORK A STj J_ L0 //' SEPTIC TANK,SEEP.PIT(S) ADDRESS. f 7f ii' / {, {�YiJ fff/ AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-'I CESSPOOL 0 DRYWELL E] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE' TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PL U MBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREDI DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ' ABANDON HOUSE SEWER ER OFAND TTHE ABTE OFCALIFORNIA VE to E8CR BED RESIT EN7IAERTY. .I Am,THE LEGAL OWN-j ' BACKFILL SEPTIC TANKS 'SEEP.PIT(S)Q CESSPOOLS a C7- SIGNATURE OF PERMITTEE:?S�C-:._:�f.... _ .....___.._.._.._... ... . _4GA642A 663 4/53 6, �ERMI'I" CLQ 76A6642DTD APPLICATION FOR COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDI7y 7 NG 77. JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS (p COLEMAN W. JENKINS. SUPT. OF BUILDING CLIi - LOCATY 6 FOR APPLICANT TO FILL IN NEARSSr CROSS 3T. (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO, OWNER MAIL BLOCK TRACT gyp) / ADDRESS NO,ABLOGS.SIZE OF LOT NOWITYTEL. NO. USE OFSTgICT NO. Gg00P CLA53 MGp PqOCE55E0 BY BUILDINGSBK pS EONTRPCTORADDRESS CONNECTION DATACIiV TEL. NTATION 7,Z �JDEPTHSTATE - ANHOLE REFERENCEE_/2Z' / UPPER LCENSE NO. cELP LkT5WER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIO p;: LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P.L. .J PUBLIC SEWER ® $5.00 �j' P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.I.P. NO. /J� JOB NO. PITS ANO/OR GRAINFIELD ® (10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. } PRIVATE DISPOSAL SYSTEM 83,D0 CL CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I RAIVIISENENT RECORD.INSTR.NO, PATE O WORK TO HOUSE SEWER $3.00 U OVERFLOW SEEPAGE PIT.GRAINFIELD EXTN..CESSPOOLDRYWELL.MANHOLE 0 E5.00 O ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT ~ V PERMIT NO. W d INDUSTRIAL N WASTE APPROVAL Z CHARGES OWNERS PERMIT s 00 AUTHORIZATION TOTAL FEE ' CONNECTION CHARGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEs APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF T I 19/ OWNER OR L� NEW HOUSE SEWER OWNERS AGENT L� CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPL ATION INO/OR DRAINFIEL. ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS.. CESSPOOL ❑ DRYWEIL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE 480 . DESCRIBED RESIDENTIAL P OPERTY. ABANDON HOUSE SEWER E/ SI OF PER E 9ACRIIIL SEPTIC TANKS OF PERMRTEE SEEP.PITISI [ICESSPOOLS ❑ VALIDATION JACK R. ALLEN CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER 1 .9 6 1� AUG17 1 0 D 6.00"