HomeMy Public PortalAbout10600 ROSEGLEN ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION.,OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10600 Rose G10a rit. CROSS ST.
LOCALITY T®mple City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. El Monts Ave. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. ids Mitt
MAR w USE ZONE OCCUPANCY MAP
ADDRESS T� SSY). Gabriel Blvd. BK PG
CITY San Gabriel TEL.NO. LT. 94.3b4 i6
CONTRACTOR L. l). & M. Cms tr. Co. g, 7-z
ADDRESS 21 kV. Wistaria rive. JOB NO.
CITY Arcadia TEL.No. DO 62238
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO.43 STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT 191A0 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT ] CHARGES
USE
BUILDINGS ]lessCONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 _� RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DAT[ BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER UGUMB
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 Y. Gu" P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 1 31 60
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF............-......-..................19_.---- NEW HOUSE SEWER SC C
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----------------------------------------_---.------•----•--•----
-----._ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS............................................ ---------------------- ---------------- AND/OR DRAINRELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[:] DRYWELL E]
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
IGNATURE SEEP.PIT(S)Ej CESSPOOLS E]
SOF PERMITTEE...L�TJ.-_ �-- 'E}2}$
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