HomeMy Public PortalAbout10606 ROSEGLEN ST_Sewer__ DEPAIVrMLNT 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 70 FILL �N. , LOCALITY
BUILDING / + NEAREST
ADDRESS (U - CROSS SL
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. C•
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY I BK MAP PG
CITY TEL.NO.
CONTRACTOR rr C0.1HP.N0.
ADDRESS /� //�� c JOB NO.
CITY ✓[,� TEL.NO. 1'�['�"�S
TRUNK PERMIT N0.
STATE
REGISTRATION N0.- ROAD PERMIT NO.
LEGAL T N0 ��f STATE ENCROACHMENT
DESCRIPTION LO . /"/� PERMIT NO.
BLOCK TRACT /�/ �� INDUSTRIAL
L-I WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS e ._ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO -i, REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I 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. DATE I 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/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
-UPfRE R LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS ( PERMIT $ 1 00 Y- sults P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE +Cz sm
I 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
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT............................................................................ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS - - - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej
SIGNATURE SEEP.PIT(S)� CESSPOOLS
OF PERM ITTEE-
76A642D 663 1/53