HomeMy Public PortalAbout10607 ROSEGLEN ST_Sewer__ DEPAWrMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING
ADDRESS 10607 Ros a Glen Sts NEAREST
CROSS ST.
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST El Molts Ave• A -S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER PPL. Me Nutt
MAIL „ � USE ZONE OCCUPANCY MAP
ADDRESS 2722 San Gabriel Blvd, I BK PG
CITY San Gabriel TEL.NO. &T• 94364
CONTRACTOR L.D. &M* C®nstr• Coo C�rIYF.JIO
ADDRESS 21 Ws Wistaria Ave, 1013 NO.
CITY Hraadia TELAO. DO 62238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 1136.3 C 42 ❑ COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. 45 PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 1 CHARGES
USE
BUILDINGSII@$ CONNECTION CHARGE FEE
s
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 � RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER 0R REPAIR EXISTING NO, I DATE 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 /--Y DEPTH
CESSPOOL—ORYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER t9Mii8
TYPE OF CONNECTION LENGTH FROM ”
OWNERS PERMIT $ 1 00 Y, SUae P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 4 50
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------------------DAY OF...................................... 19NEW HOUSE SEWER 5he
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_...............................-.._..-•----------------------------- - BUILDING OR WORK
-..---_-- SEPTIC TANK,SEEP.PIT(S)
ADDRESS.......................-.
- - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL E) 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
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 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SEEP.PIT(S)� CESSPOOLS�
SIGNATURE I,s-.Ds_8C � C1StrL_�tl�i._.---•--------.-
OF PERMITTEE
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