HomeMy Public PortalAbout9850 LA ROSA DR_Sewer__ CE808- . APPLICATION FOR PERMIT
Qsaoe-e-se COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUII,DING AND SAFETY DIVISION BUD LD I ADDRESS
f/� r-
_ ]OHN A. LAMBIE, County Engineer ADDRESS d J
CASSATTT D. GRIFFIN, Sup't of Building LOCALITY C
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. A(>IV l
LEGAL � J '�
DESCRIPTION LOT NO. -/ '/ \I�,fy-�qit' �,�� J OWNER \ /T 1n4 J (� eah) y' [•()
BLOCK, TRACT Gp �'� MADL �� � La R�� RQ[
!! / ADDRESS
NO.OF BLDGS -s
SIZE OF LOT NOW ON LOT CITY EL.NO. O3
USE OF
BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY
BK PG
CONTRACTORA. , ./-/))I/•
ADDRESS (," 7Al CONNECTION DATA
CI J .rEL. N0. STATION /.��.� �� DEPTH
REGISTRATION NO. J�1111271 COUNTY MANHOLE REFERENCE. O UPPER-
No. DESCRIPTION OF WORK FEE D OWER•
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 OQ TYPE OF CQpiM@C7ION LENGTH FROM LI
PIEPTIC TS ARU%OR DRAINFIELDPAGE $3.00 OR @ $3.00 Y. URB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO ^J P. C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO.. ia1 D� JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER It $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. b
ALTER,REPAIR OR ABANDON HOUSE 'STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S- PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE OD REI MBURSEMENT.FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINMROF
G DWELLING
TO THE PUBLIC SF;
SIGNED THIS n y OF C- i NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS 5D SEPTIC TANK,SEEP, PIT(S)
ANO/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE REPLAND STATE THAT THE ABOVE IS CORRECT AO CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATGUALTER. REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLYD DISCONNECT PLUGANDLICENSED AS REQUIRED BY LOS ANGELES CSABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEGA H p L
DESCRIBED RESIDEN L ROP TY. BACK,I SEEP. PIT(3)POD CESSP00❑LS❑
SIGNATURE -� ✓
OF PERMITTE
VALIDATION,—) ROBERTA.WOOD
y,g 1JG�H SUPERVISING MECHANICAL ENGINEER
a r�X6.9._4 7 M NOV 3 1 0 A 5 .0 U .r
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