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 '