HomeMy Public PortalAbout9967 LA ROSA DR_Sewer__ DEPARTMENT of COUNTY ENGINEER ' � SEWER-SEWAGE DISPOSAL_
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGET.FS
WILLIAM J. FOX, COUNTY ENGINEER ,'I ADDRESS �� V�V yLli
FORA L CANT TO FILL LOCALITY
_BUILDING NEAREST 0
AOGRESS CROSS ST. �. !A-/��"�-`�"`�'
IOCALITV -DISTRICT NO. SERIAL NO.. 'PERMIT NO.A �30 J
�•
NEAREST P J
CROSS ST. ("/v
'RECEIYED'BYE^D/' Y Ready for Inspection DATEISSUED
OWNER I I'ICJ.J 1' /r% P'L�//��JL 1��2T—✓ _
MAIL `
.ADDRESS USE ZONE OCCUPANCY MAP PG
�l LO.-
CITY TEL.NO. —/ - K
CONTRACTOR L _ Y CO.IMP.NO.
ADDRESS X�iC 7 7 JOB.N0.
CITY�/•�Yii/e l0.}�TEL.NO. , -STATE/ TRUNK PERMIT NO.
REGISTRATION NO. '/� lqf ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO�f�p �� #`� STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT ���/ j INDUSTRIAL
WASTE APPROVAL
NO-OF
-
SIZE OF LOT ,J NOW ON LOTS I <CHARGES
USE OF
BUILD'NOS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE /
HOUSE SEWER CONNECTING TO /r
PUBLICSEWER 0 $ 3.50 RECEIPT N0. IDATE I BY
HOUSE SEWER CONNECTING TOS
PRIVATE DISPOSALSYSTEM 1.00
CONNECT ADDITION AL BLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 I
ALTER OR REPAIR EXISTING NO. /DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER -
- AID/oR oBPOSAL'SYSTEM' 1.00 - - - CONNECTION DATA
S EPTIC TANK,SEEPAGE PIT OR - - - -
PITS AND/OR DRAINFIELD 2.00 STATION/) 7-6 ?, O r DEPTH Cl
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00AiANHOLE UPPERR--
TYPE OF CONNECTION - LENGTH FROM 3D /
OWNERS PERMIT 6 I DL
CURB// T=7 M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 ,
1 HAVE THIS DATE CONTRACTED WITH ES HEREIN NAMED _
��.��- I� APPROVALS INSPECTOR'S IGNATU RE DATE
DWELLING
TO CONNECT THE ABOVE ESCRIBED EXISTING!
DWELLING TO THE PUBLIC SEWER / i i -
x\ NEW HOUSE SEWER
SIGNED:THIS--- 1 .DAY _.._
OWNER OR icy-/,aii CONNECT ADDITIONAL
OWNERS AGE !ll��, _ _ r_id BUILDING OR WORK.
_.
��/+�+ ��'J , !��}y/'�,/ SEPTIOTANK,SEEP.IELD PIT(S)
ADDRESS........ �.---.-.-.--i..`...::r+s-'1!�- ANO/OR DRAINFIELD '
1 HEREBY ACK N()WLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL Q DRYWELL El
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 REGISTEREDDISCONNECT PLUG AND
_
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HO PLUG AND
AND STATE OF CALIFORNIA OR THAT 1,AM'TIIE LEGAL OWN-
ER OF.THE ABOVE DESCRIBED REST ENTIAL PROPERTY. BACKFILL SEPTIC TANKS �.�.•
• SEEP.PIT(S)[-CESSPOOLS b - G AO_
SIGNATURE /rL `�/ _ /
OFISIGNATURE
ITTE E. !__..__...�--.....-.._. .-.-_--
76A642A 663 7/53 �� ,e�"_� i