The URL can be used to link to this page

Home My Public Portal About9856 LA ROSA DR_Sewer__ CEBOS 10-63 / l 76A642D APPLICATION FOR .PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING L r JOHN A. LAMBLE, Counly Engineer ADOHEss e! C. WILLIAM A. JENSEN, Sup'1 of Building LOCALITY NEAREST FOR APPLICANI_,TO FII.L IN , , CROS$ ST G /�o�� LEGAL L DESCRIPTION LOT NO. /` OWNER MAIL BLOCK TRACT / ADDRESS �S/ y C NO. OF SLOGS. 512E OF LOT NOW ON LOT CIT TEL. NO. USE OF /J BUILDINGS �/ LVC [ L-L DISTRICT NO, GROUP MAP Pfl OCEBSEO BY BK PG CONTRA C , /_ L �/ �C C0. ADDRESS ' CONNECTION DATA CITY T.L. NO. Gr 1:I'- / CSTATION DEPTH �J E UPPER REGISTRATION NO. C. COVNTY MANHOLE REFERENCE TY NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEW ER CONNECTINGTO Y. CURB P.L. M.L.TO P.L. r PUBLIC SEW ER 45.00 CL EPTIC STANK.SEEPAGE PIT OR JOB NONO. PIT.ANO/Oft DRAINFIELD SIO.00 CO.IMP, NO. OB . Q HOVSE SEWER CONNECTING TO V PRIVATE DISPOSAL SYSTEM S3.00 TRUNKZPE MTNO. ��gOAD PERMIT NO. CONNECT ADDITIONAL BLOG.OR AFFIDAVIT wnrvu I IA514HiTRECORD. INSTR.NO. DATE 0 WORK TO HOUSE SEWER ® 43.00 J� OVERFLOW SEEPAGE PIT.GRAINFIELD LJ C ESSPOOL,DRYWELL.MANHOLE Lb $5.00 W a ALTER RE FAIR OR ABANDON MOUSE HWY.OR ST.WIDENING .> �O Z OR DISPOSAL SYSTEM ® 33.00 J STATE ENCROACHMENT PERMIT NO, INDUSTRIAL f WASTE APPROVAL CHARGES OWNERS PERMIT S 2 OG CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS GATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER, SIGNED THIS DAY OF 19_ OWNEROR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTICEEI. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/.TANK,SFIEL PITT S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY A'NO/OR GRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ r 4 [ / IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER ORe LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE.DISPOSAL;SYSTEM CALIFORNIA OR THAT 1 THE LEGA WN OF, D INTEND TO DISCONNECT PLUG AND RESIDE IN. THE 4B0 ESCRIBED REST. IA PERTY. ABANDON HOUSE SEWER SIGNATURE - BACKFILL SEPTIC TANKS ❑ ITTEE OF PERM ❑ PIT ISI ❑ CESSPOOLS LIGATION ROBERT WOOD cases SUPERVISING MECHANICAL ENGINEER [j{[; 3 9 9 9. SEP 21 1 0 D 5.0 0" IN CEBOBAPPLICATION FOR PERMIT BA642D COUNTY,OF LOS ANGELES SEWER-SEWAGE DPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING TORN A. LAMBIE. CouatT Engineer ADDRESS WILLIAM A. IEN9EN. SuP'I of Building_ LOCALITY If NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL VL/ DESCRIPTION LOT NO. me if OWNE BLOCK TRACT MAILMJVU SIZE OF LOT , n I" •j.J NOW ON LOTS CITY / TEL. NO /I b(/ OF �O1 ADORES USE OF BUILDINGS DISTRICT NO. R YAP PROCESSED BY CONTRACTORBK PG rD — ADDRESS CONNECTION ASA / CITY TEL.NO J STATION / /L7 DEPTH TATE REGISTRATION NO. i B COUNTY MANHOLE REFERENCE C No. I DESCRIPTION OF WORK FE HOUSE SEWER CONNECTING TO v PUBLIC SEWER @ $3.00 1 L� TypE 0 ONNECYION LENGTH FROM Y.SEPTIC TANK.SEEPAGE PIT OR TCURB P.L. Y.L.TO P.L. c J PITS AND/OR DRAINFIELD @ SS.00 OVERFLOW SEEPAGE PIT.DRAINFIELD Y EXTN.,CESSPOOL.DRYWELL C. S2 11 d HOUSE SEWER CONNECTING TO ,�,� t` P.C.N0. O PRIVATE DISPOSAL SYSTEM @ SI.00 CO. IMP. NO. 3(� JOB N0. V CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. 971 Od ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT H SEWER OR WEROR DISPOSALSYSTE @51.00 PERMIT NO. V INDUSTRIAL W a WASTE APPROVAL N CHARGES ? OWNERS PERMIT S 00 CONNECTION CHARGE FEE AUMORMATION I TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DTE( INSPECTOR'S SIG TORE TO THE PUBLIC SEW )I SIGNED THI DA OF 19� NEw HOUSESEWER OWNER OR L 5 CONNECT ADDITIONAL �y'T OWNERS AGEN 1� d BUILDING OR WORK // -+.Y✓/.'� ADORES SEPTIC TANK,SEEP.PIT($) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVEIS. CORRECT AND AGREE TO COMPLY CESSPOOL [IDRYWELL WITH ALL COUNTY ORD]NANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR I HEREBY CERTIFY THAT 1 AN PROPERLY SEWAGE DISPOSAL SYSTEN REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES CO Y AND E E OF ABANDON ROUSE SEWER CALIFORNIA OR THAT I M THE l G NER OF 2'XF ROVE DESCRIBED RESIDENTI P PER T. /._ BACKF I LL SEPTI C TANKS ❑ SIGNATURE SEEP. ILL ❑ CESSPOOLS OF PERMITTE VALIDATION ROBERT A. WOOD CL Y.O. WN SUPERVISING MECHANICAL ENGINEER 6,00 Az"