HomeMy Public PortalAbout10650 ROSEGLEN ST_Sewer__ I DEPA19TWENT OF OOUNW ENCOTEM SEWER-,SEWAGE DISPOSAL 1
DMSION OF HUII.DING AND SAFETY PERMIT APPLICATION
WUN Y,OF IA)8 ANGEL
WILLIAM J. FOX, CoUNrY ENOIN[rn BUILDING
ADDRESS
FOR APPLICANT TO RLL IN LOCALITY
BUILDING EAREST
ADDRESS 10660 Rooe Gla n St. PROM ST. �
LOCALITY Temple City DUMMOT IRO. SERIAL NO. PERMIT NO.
NEAREST El IL'oJt a Ave. ACROS
BE EIVFFD BY Raft fw lug DATEISSUED
OWNER P.L. Mo Hutt ;j, /I- /7— S
MAIL USE ZONE PANCY MAP
ADDRESS 272* Sg-_Gahri Al In vd JJ BK PG
CITY Sari Gabriel TELNO. AT 94364 _ r,
OONTRACTOB L.D. & M. Constr. Co.
GL1=JYR-NO. .C -2--7 Z
ADDRESS Pl W, Aiatsr is Ave. JOB M0.
CITY Arcadia TELNO. DO 6 2238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 IH COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENOROAOHMENT
36 PERMIT NO.
BLOCK TRACI9189 INDUSTRIAL
APPROVAL
SIZE OF LOT NO.OF BLDGS
NOW ON LOT 2 CHARGE
USE OF
BUILDINGS CONNECTION CHARGE FE[
NO. DESCRIPTION OF WOV FEEHOUSE REIMBURSEMENT FEE
l PUBLICSEWERCONNEOTINGTO . &50 3 60
RECEIPT M0. D TE BY
HOUSE 8 ER CONNE INS 0
PRIVATE DISPOSAL SYSTEM 1.10
O-ONNEOT ADDITIONAL S-OR EXCEPTIO RECORDED
WORK TO HOUSE SEWER I.QO
ALTER R PAIR N NO ATE BY
SEWER OR DISPOSAL SYSTEM IAO
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TAP , . O
PITS AHD OR GRAINFIELD 240 STATION f �, D DEPTH 1p
ELL
SPECIAL CONDITIONS ONLY LOQ MANHOLE REFERENCE
UFF%&R- LOWER
TYPE OF CONNECTION L�LENGTH FROW'_
OWNERS PERMIT $ 1 Q0 11*_ P.L M.L.TO P.L
AUTHORIZATION TOTAL FEE 4 b0
I HAVE THIS DATE CONTRACTED WITH TH[ 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 SEWER C- �r
O —
WNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
LDISGONNECT
ANK SEEP.PIT(i)
ADDRESS DRA NFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- L❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY,WITH ALL COUNTY ORDINANCES AND STATE LAWSEPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. DISPOhiL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTYECT PLUG AND.AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- N HOUSE SEWER
EB OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. I A ❑(S)❑ OESSPOOLi 0
SIGNATURE
OF PERYITTH
fU"M H3 1✓53 ,+�'./C`�✓r -�3r ly Y �.lf 1l�'�.•` f)J J�.�
7@A6410APPLICATION FOR PERMIT
•�I[.�u tt-u 7-
DI14ISION OF BUILDING AND SAFETY S EINE R-5 EWAI E D 1 S POSH L y
D"-rt%*W of Co—t7 F-gbm e
Cva of Loi Ate" BUILDING
JOHN A. LAMBIE, COUNTY ENGINEKR A.DDRE°D `
9 evce4
It CASSATT G.GRIFFIN, $UP�T OF BUILDING LOCAL M TL
XLAREffT
FOR APPLICANT TO FILL IN rs
LEGAL ��
DESCRIPTION LOT X0. 35
TAIL
BLOCK TRACT ADDRESS rRas la i-I
NO. OF BLDGD. CITYrr
TEL, N0.
SIZE OF LOT NOW ON LOT
UDE OF
aUILDINGd DISTRICT NO. G OUP t"
BK PG
conTRAcroN
ADDRESS COM(=ON DATA
STATION DEPTH
CITY TEl- N0. MANHOLE RBFIaFI CE UPPER
❑ STATE LOWER
REGISTRATION No. ❑ COUNTY
No. DESCRIPTION Of WORK FEE 147
HOUSE SEWER CONNECTING TO [0 CONNECTION LEND OY -
PUBLIC SEWER
Y. URD P.L. M, P.1-
SEPTIC T"K,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 1,00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. NO. JOB NO.
EXTN.,CESSPO L;DRYWELL,MAXH6LE B S 2.60
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEY :1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROAC NT
WORK TO HOUSE SEWER ® S 1.00 PERMIT NO.
ALTEA,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 1.00 WASTE APP YAL - -
CHARGES
CONNECTION CHARGE FEE
OWNER'S BEIMn s oo •
AUTHORIZATION TOTAL FEE REI�BURSEYEMT FEE
1 HAVE AT THI3 DATE A CONTRACT WITH THE HEREIN NAMED COX- APPROVALS DATE IMSPECTOR•3SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. MEW HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECTADDITIONAL
OWNER OR BUILDING OR WORK II I
OWNERS AGENT SIEPTIC TANK,SEEP,PITS)
ADDRESS AXD/OR DRAINFIELD
IH
ACKNOWLEDGE THAT 1 HAVE REAP THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND SCATS THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM _
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
CT PLUGHOUSE R
cI�LIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ r
SIGNATURE r SEEP.PIT S) ❑ CESSPOO ❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY E.I•IGINEER ?-01�pyIDAMN ROBERT A.WOOD, CHI[F PLJ90. IN43PHCTOR
�6621OR ff0v13. 1. 0 -A 3.00 N