HomeMy Public PortalAbout10641 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
ADDRESS 10641 Rose Glan 3t• CROSS ST.
LOCALITY Temp 1a (;ity DISTRICT NO. SERIAL NO. PERMIT NO.NEAREST A S c
CROSS ST. Ll;l Mont e Aveo
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. McNutt
MAIL
ADORESS 272-:2k San Gabriel Blvd• USE ZONE OCCUPANCY MAP
BK PG
CITY San Gabriel TEL-NO- AT 94364
CONTRACTOR L. D. & lul• Constr. Uo• C0.11Ns�N0.
ADDRESS 21 fir• 'distaria Aw •
JOB N0.
CITY readia TEL.NO. ® 4
z3bTRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. Q PERMIT NO.
BLOCK TRACT 191f39 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 2 CHARGES
USOF
BU IE
DINGSB86• & Gar a&e CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 _ JSP RECEIPT NO. DATE (BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK T_0 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/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER C'QtiKE R
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 00 Y- CUSS P.C. 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 INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------------------DAY OF................-......................19..._.. NEW HOUSE SEWER -5e-A Y
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 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 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
ESEEP.PIT(S)C] CESSPOOLS I]
SOF PERMITTEE L!
TTE .._D►.._ - .•-..S'iSItstr...-fie.----------
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