HomeMy Public PortalAbout9940 LA ROSA DR_Sewer__ T6AS42D v
CE8088.59 APPLICATION FO PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF-COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING p.
]OHN A. LRMBIE. County Engineer ADDRESS -
CASSATT D. GRIFFIN,Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS sr.
LEGALOWNER n
DESCRIPTION LOT NO.
BLOCK TRACT (7/ Ai` MAIL ,T
ADDRESS. (/
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY V . NO.
USE
BUILD,NGS DISTRICT JOCESSEO BY
t �O NO.I OUP I AP PG
CONTRACTORAT-Ilp Cnnst
S�II"•(7.r VyIII
ADDRESS V CONNECTION DATA
9�329 [Y' �.
CITY So. El Monte TEL.NO. C*I 8-6565 STATION DEPTH
$] STATE MANHOLE REFERENCE
REGISTRATION NO. ❑ COUNTY _ LOWER
NO. DESCRIPTION OF WO FEE
/ HOUSE SEWER CONNECTING TO ,r
PUBLIC SEWER @ $3.00 TYPE OF CTION LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. C B P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EKTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB N0.
CONNECT ADDITIONAL BFG.OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TOHOUSE SEWER ( AhG 4, @5600
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES.
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVECON-
TRACTORA TO CIONNECT THE ABOVE DESCRIBED EXIISTINGDATE A CONTRACT THE HEREINAMED DWELLIING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER. /
SIGNED THIS 1�` DiAY1O—F 19_ NEW HOUSE SEWEROWNER OR
OWNERS AGENT �`'T `T°�'✓`-'�"�' _BULL CT ADDITIONWORKAL
ADDRESS SEPTIC TANK.SEEP.PIT(S)
_AND/OR.DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. —ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR —
LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEG L OWNER OF HE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PIT(S) ❑.CESSPOOLS
❑ n
OF PERMITTEE 9 C
). ,
®' MMAT.ION ROBERT A. WOOD
M.o. GSH SUPERVISING MECHANICAL ENGINEER
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