HomeMy Public PortalAbout9914 LA ROSA DR_Sewer__ CE80810-63 APPLICATION FOR PERM T
]6A662D
COUNTY OF LOS.ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDIrvc
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY _
NEARES
FOR APPLICANT TO FILL IN CROSS 6T.EGAL
—
DESCRIPTION - LOT NO. _ • // J [ OWNER
MAIL
BLOCK TRACT ADDRESS
NO. OF BLDGS.,
7'
SIZE OF LOT yQ NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROUPI MAP I PROCESSED BY
BUILDINGS -
■3��� II���x��' /�(�/� BK PG
CONTRACTOR �� 'S v & T[]/y `/
ADDRESS w/n �3_/ / w++ CONNECTION DATA
CITY I /'3 EL. F{1 L+�-I_HH-I-«�----IRR---iiiff169T STATION DEPTH
V- �•
UPPER
MANHOLE REFERENCE
REGISTRATION NO. COUNTY HLOWER
NO. DESCRIPTION OF WORK FE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER ® 39.00 P_C,NO_ a
SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB NO, O
PITS AND/OR ORAINFIELO @ 510.00 T V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISROSA L SYSTEM ® S3.00
------------
CONNECT ADDITIONAL BLDG.RG AFFIDA uv u5[x[xi ftECOR D.INSTR. O. yDA E O
JP TO MOU6E SEWER @ $3.00 //
OVERFLOW SEEPAGE PIT,DRAINFIELD V -" W
EXTN..CESSPOOL,DRYWELL,MANHOLES 55.00 N
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT Z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGE6
OWNERS PERMIT $1 2 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'I HAVE AT THIS GATE A CONTRACT WITH THE HERE/ AHED CON.
REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTORS SIGNATURE
SIGNED THIS DAY OF-19—
OWNER
F19_OWNER OR NEW HOUSE SEWER
OWNERS AGENTCONNECT ADDITIONAL
V_
Jn•
BUILDING OR WORKRK /,A,�/>-�Z� r- ���f•�.��
ADDRESS SEPTIC TANK,SEEP,PITIS)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR.SEWER OR
LICEN 5ED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWA G E DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL CWbKR OF. AND INTEND TO OIBCONNECT PLUG ANO
RESIDE IN, THFOV CRE �IALPERTY' gBANDON HOUSE SEWER
SIGNATUREBACK F ILL SEPTIC TANKS ❑
OF PERMITTEE BEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATION ROBERT WOOD
SUPERVISING MECHANICAL ENGINEER
' M.0. CASH
LAAO 5 2 9 3.o OCT 27 1 0 D 5.0 0-