HomeMy Public PortalAbout10629 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 ENm NEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10623 Rw ® Glen St. CROSS ST.
LOCALITY Temple (ii ty DISTRICT NO. SERIAL NO. PERMIT NO.
A S
C OSS ST. El konte dive e �
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER PcLcjljj�tt
MAIL 1 USEZONE OCCUPANCY MAP
ADDRESS 2?�a San r—ghri al- tsjld BK PG
CITY San Gabriel TEL-NO. ATS 4 364
CONTRACTOR ,
-n��e l+d I.(11c--. a—r( CO.IMP.NO:.
ADDRESS 21 ifs Wistaria Ave. JOS NO.
CITY Areadia TELAO. DO 62238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113x;13 u 42 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 48 PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CHARGES
USE OF
BUILDINGSROS s & Gara6,e CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO _
PUBLIC SEWER @ $ 3.50 F 0 RECEIPT NO. DATE I BY
ROUSE 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 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
UgAws 11 LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 µ` 614RQ. P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 1 41 5o
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......._..._._............_........19..._... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------ ------_-•--------_._------------._---------- _ BUILDING OR WORK
ADDRESS.................._--.-_._._-------------------------------------------------------------- SEPTIC TANK.SEEP.PIT(S)
-- - - AND/C TANK.SEEP.
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
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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
NATURE SEEP.PIT(S)� CESSPOOLS
SOFPERMITTEE--- ----.---•_
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