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HomeMy Public PortalAbout9955 LA ROSA DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1 DIVISION OF BUILDING.AND SAFETY PERMIT APPLICATION BUILDING COUNTY OF LOS ANGELES - /'/N- WILLIAM J. FOX. COUNTY ENGINEER II ADDRESS 99.T.S A•LQY/n.d'�®� FOR APPLICANT.QTO FILL IN LOCALITY BUILDINGADDRESS AR �i9,5'S ,Ca ) �",�, NEEST �� . /1 l� CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. �• NEAREST : A 25� O`" � S CROSS ST, RECEIVED BY Ready for inspection ` DA/T^EISSUEAD OWNER /�• ?,Q-I c.^r' J'�O-��Y MAIL 'S /_ �U,i� E ZONA OCCUPANCY MAP ADDRESS Sd"H USE BK PG CITY Sl:!* - TELAO. CONTRACTOR M. C. koffingham Co. of Temple City CO.IMP.N0. 13�� ADDRESS 5933 N. CLOVERLY AVE. )OB NO. CITY TEMfiLE N�11. C LIF. TRUNK PERMIT NO. P09TAYE REGISTRATION NO. r �r-/l�I�OO COUNTY ROAD PERMIT NO.LEGAL DESCRIPTION LOT NOL4'D�/ I{ 71 LCL A'3 STATES NCROACHMENT -- PERMIT N0. BLOCK TRACT INDUSTRIAL WASTE APPROVAL 512E OF LOT S'40 L S NO.OF NOW ON LOTS / CHARGES USE DI CONNECTION NAQGEFEE / USE OF N0. DESCRIPTION OF ❑RK FEE ROUSE SEWER CONNECTING TO REIMBURSEMENT FEE / PUBLIC SEWER C $ 3.50 S� .RECEIPT NO. /DATE\IBV HOUSE SEWER CONNECTING TO PRIVATE DISPOSALSYSTEM 1.00 CONNECT ADDITIONAL S-SEWE BLDG.BR / / OEXCEPTION DATE RDED BY \ -' WORK C HOUSE SEWER - 1.00 ALTER OR REPAIREXISTING SEWER OR BISPOS ALSYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM I.DD CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR GRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 IMANHOL REFERENCE gc� \n R _TYPE OF CONNECTION LENGTH FROM C I OWNERS PERMIT $ I 00 r CURB) "F-I= M.L.TO P.L. J AUTHORIZATION I TOTAL'FEE' /L $-O I HAVE THIS DATE CONTRACTED WITHABOVE THE HEREIN NAMED CONTRACTORDWELLING TO CONNECT THE ABOVE DESCfl18ED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TOT __�JI�LIC SEWER SIGNED THIS .... __. 1 NEW HOUSE SEWER _DAY OF.... . 19... OWNER OR CONNECT ADDITIONAL OWNERS GENT. ._.. . _:.... ... ..,a.. BUILDING OR WORK EPTIC AD D BESS...�ia�.S' .L2....._ - . .r..._..._\... .. AND/OR DRAINF ELD PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL DRYWELL 0 CATION AND STATE THAT THE ABOVE IS 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ER OF THE ABOVE DESCRIBED -%gESIDE&rIAtt,p�tOPE�tT1' BACKFILL SEPTIC TANKS SIGNATURE M. C. IVDfflnFham (�tf. OT IPm�le 1.I�V SEEP.PIT(S)� CESSPOOLB� OF PERMITTE __...---- -------- .----------- ........_.._..._.._......_.........._..._... 76A642A 663 7/53 �f// )" L r M/i . ©/ 1