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HomeMy Public PortalAbout9932 LA ROSA DR_Sewer__ 76A6420 • SA E-66 � APPLICATION FOR PERMIT 1 69 E�6L'IVISION.OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS oL ® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS sr . LEGAL y O OWNER DESCRIPTION LOT N0. IJ�— / MAIL BLOCK TRACT p / ADDRESS / }} / �/ N0.OF BLOGS. CITY TEL. N0. SIZE OF LOT/,2 4-4 y NOW ON LOT � USE OF DISTRICT NO. GROUP MAP BUILDINGS ,T BK PG CONTRACTOR tJl �. CONNECTION DATA ADDRESS CITY TEL. NO.G�/�-� '/ / STATION DEPTH f!' MANHOLE REFERENCE UPPER ❑ STATE 41- LOWER REGISTRATION NO. ❑ COUNTY / is No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $ 3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. EXTN.,CESSPOOL,DRYWELLMANHOLE- $2.00 CO. IMP. NO. 10B NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR 1 STATE ENCROACHMENT WORK TO HOUSE SEWER @ $ 1.00 PCf PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ S 1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PEST s o0 AUTHORIZATION TOTAL FEE c5?, REIMBURSEM ENT'FEE i HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING NG TO THE PUBLIC SEVER. NEW HOUSE SEWER SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT SEPTIC TANK,SEEP, PITS) ADDRESS AND/OR DRAINFIELD IIT ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL CIDRYWELL LlAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL 0 NER OF THE ABOVE 0 SCRIBED RES DENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ NATURE SEEP. PIT(SI Q CESSPOOLS❑ PERMITTEE JOHN A. LAMBIE, NTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR C6. M.D. CASH LACO20791S SEP 10 4 2.00 0 DFPARTbEENT OF COU= ENGWFXR SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION BOUNTYNGE WILLIAM J. FOX, CO COUNNTY ENGINEER ADDRESS BUILDING Q U „� FOR APPLI(;4NT TO FILLIN LOCALITY BUILDINGS NEARET ADDRESS qC bbb(((QI rl CROSS ST. • .v ,CL/1M `-�'r�K LOCALITY �` � ' DIST�R'I''C'T`NO. SERIAL NO. PERMIT NO. NEAREST `-� A 'I-164-21S CROSSST. RRECEIVE.DODY'-, Ready for Inspection DATE/IISSUED OWNER �7•• / — —537 MAILUSE 20NE OCCUPANCY --MAPF ADDRESS �� / BK PG CITY TEL.NO. , �`" 13 � �e E— CONTRACTOR `� . I��� w ''Cr" /�D S- �7 I , _ �,/ r CO. NO. ADDRESS Q?, f a/V 6\ arl G-a b. a Vic( JOB.NO. CITY S S' /G TEL-NO. /'� O 41712- 7' 2— TRUNK PERMIT NO. REGISTRATION NO. COUNTY' ROAD PERMIT N0. LEGAL ; DESCRIPTION LOT NO. OY,DSTATE ENCROACHMENT ` PERMIT NO. I' BLOCK TRACT �} INDUSTRIAL \ f--/ WASTE APPROVAL S12E OF LOTdNO OF NOW ON LOTS / \ CHARGES USE OF CONNECTION CHARGE FEE\ BUILDINGS NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 3.50 B Sd ' RECEIPT N0. I DA\ I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR CEPTION RECORDED WORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING ✓N I GATE \ I BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1-00 CONNECTION DATA SEPTIC TANK,SEEPAGEPI TOR PITS AND/OR DRAINFIELD 2.00 STATIONf� % DEPTH IU CESSPOOL—DRYWELL _SPECIAL CONDITIONS ONLY 2.00 MANHU Opp E�R-EFERENCE LOWER _ T'-TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT f I 00 " CURB _114- M.L.TO P.L. J AUTHORIZATION TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER��JJ SIGNED THIS.I.dI._......DAY OF._ t"G _—_19.,yS![DISCONNECT EW HOUSE SEWER OWNER OR _ /- ONNECT ADDITIONAL OWNERS AGENT _.._ a._ .._. '?"WrC"KE1L�. UILDING OR WORK _.._� ...._. ._._ a p�/ �7 EPTIC TANK,SEEP.PIT(S) ADDRESS.....j..../.... .. 9..:.....,LI.LG!__,.._...................... ND/OR GRAINFIELD . 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- ' ESSPOOL Q DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSLTER, REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. EWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF CALIFORNIAIOR THAT 1 AM THE'LEGAL OWN. ABANDON HOUSE SEWER ER OF THE ABOVE-DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Pl- SIGNATURE ���—A lc.r SEEP.PIT(S)C] CESSPOOLS E3 OF PERMITTEE............_. 76A643A 663 7/53 '