HomeMy Public PortalAbout9832 LA ROSA DR_Sewer__ safe 311.55 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE. DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING A
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT 0. GRIFFIN. SUIT OF BUILDING LOCALITY
FOR APPLICANT TO FILLj1NCROSSS S
LEGAL J� OWNER y
DESCRIPTION LOT N0. A
BLOCK TRACT / � ADDRESS
NO. OF BLDGS. CITY TEL. NO. Q I�
S12E OF LOT - NOW ON LOT
USE OF
BUILDINGS DISTRIC GROUP MAP
PG
CONTRACTOR J . / � BCONNECTION DATA
ADDRESS ^1'ZCITY s ` TEL. N0. STATION DEPTH
MANHOLE REFERENCEpREGISTRATION NO. -2 O
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CT
LENGTH FROM /
PUBLIC SEWER @ S 3.50 \ CUR=S dam/ M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD P. C.
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ S 2.00 CO, IMP. NO.1-3e-5 3DB NNO0.
HOUSE SEWER CONNECTING TO f 0�7
PRIVATE DISPOSAL SYSTEM @. $LOO TRUNK PERMIT NO. - ROAD PERMIT NO
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 100
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
�Q APPROVALS DATE INSPECTOR'S SIGNATURE
I HAVE AT THIS GATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE NEW HOUSE SEWER 12
SIGNED TRI19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYW ELL❑
ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM fHE LEGAL OW0jR OF THE ABOVE
DESCRIBED RESIDENTIAL PTY. BACKFILL SEPTIC TANKS E-1SIGNATURE SEEP.PIT($) ❑ CESSPOOLS
OF PERMITTE
JOHN A. LAMBIE. COuy Y ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
C
m.0. GSH
�
325O„' DEC11 4 4.50 m