Loading...
HomeMy Public PortalAbout10634 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 ADDRESS 10634 tH®Se ule n 3t o NEAREST CROSS ST. LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO. ceoss sal Lorit e Ave. A /f S2 $ RECEIVED BY Ready for Inspection DATE ISSUED OWNERp., o NG Nl7tt — 1 MAIL 1 USE ZONE OCCUPANCY MAP ADDRESS 92j7Snn (lch rila Blvd. I BK PG C1TYSw& Gabriel TEL.NO. AT 94364 CONTRACTOR T,.T). & M, C©nstr. CO. CO_iMA NO. ADDRESS 21 iVe I+siSt3Y'lA Ayg,a JOB NO. CITY Areadia TEL.NO. DO 6 =6 TRUNK PERMIT NO. STATE REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. 38 PERMIT NO. BLOCK TRACT 19189 INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLOGS. NOW ON LOT 2 CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE N0. DESCRIPTION OF W RK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE 1 PUBLICSEWER $ 3.50 _ 3 50 RECEIPT NO. DATE 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 140- 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 / Z, U DEPTH CESSPOOL—ORYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER L7Y�MER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT $ 1 00 Y_ mm P.L. " M.L.TO P.L. AUTHORIZATION I TOTAL FEE 1 4 5Q I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS--------------------DAY OF....................—..................19 — NEW HOUSE SEWERA y OWNER OR CONNECT ADDITIONAL OWNERS AGENT--------------------------------------------------------------------- - BUILDING OR WORK ADDRESS............................................----. __ SEPTIC TANK,SEEP-PIT(S) - - - - ANO/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 1 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 OF PERMITTEE---I,. _-- -------- 76A642D 663 1/53 ;