HomeMy Public PortalAbout9921 LA ROSA DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER BUILDING ,�•�
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY T_
BUILDING NEAREST
ADDRESS a��_� CROSSST.
LOCALITY �o/yi�� DISTRRIICT^NO. SERIAL NO. �P�jERMIT NO.
NEAREST "� �`•�
CROSS ST.
RECEI �I Reedy for Inspection / UEU
OWNERMAIL � /yliu
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ADDRESS BK PG
CITY / EL.NO. ,����/ —/ �G•+�7 I �3
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CONTRACTOR O• CO.IM P.NO: 130 '5 "757
ADDRESS JOB.N0.
CIT ' TELAO. TRUNK PERMIT NO.
REGISTRATION NO. ` COUNTY ROAD PERMIT NO.LEGAL
/Q y
DESCRIPTION LOT NO. �� ♦ �_ h' STATE ENCROACHMENT
` /� PERMIT NO.
BLOCK TRACT A// INDUSTRIAL
.(
WASTE APPROVAL
SIZE OF LOT_3x C 6 NO.OF BLDGB.
NOW ON LOT CHARGES /
USE OF
BUILDINGS 1311'114ezlewee41
CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER S 5.50 °• RECEIPT NO. TE BY
HOUSE SEWER CONNECTING TO /> DA
P R IVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR
EXCEPTION RECORDED
WORK TO HOUSE SEWER1.00 I70.
ALTER OR REPAIR EXISTING / I DATE\ IBY
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION Z �'� 3♦ Q DEPTH
SPEC ALCOND T ONS ONLY 2.00 /� 7 ,, MANHOLEJIEFEfl ENCE
y / / /UPPERJ � L•GWER
—rTYPE OF CONNECTION LENGTH FROM Lam'
OWNERS PERMIT $ I 1 GD Y. GD'te' .4 L:, M.L.TO P.L. V
AUTHORIZATION TOTAL FEE I el ED
S-®
CONTRACTOR TO CONNECT THE ABOVE D SCRIBED EXHAVE THIS DATE CONTRACTED WITH THE HERElil ISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THk P ELIC SEWER
SIGNED THIS:..'' DAWOF: _—_..19.,L� NEW HOUSE SEWER
_..
OWNER OR� CONNECT ADDITIONAL F v
OWNERS AGENT K[_� r.._._ ��,G'..!�� BUILDING OR WORK
..1- ._..�.. �� _ .
ADDRESS. io ...__�_-�.__...}.._ .... .. AND/OR GRAINFELEP.D PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL Q DRYWELL El
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT THE LEGAL OWN-
ER OF THE ABOVE RIBED HE NTIAL P PERTY. BACKFILL SEPTIC TANKS
00' / SEEP.PIT(S)0 CESSPOOLS
SIGNATURE /♦, 6�P•'V//
OF PERMITTEE.
76AG92A 603 7/53