HomeMy Public PortalAbout10651 ROSEGLEN ST_Sewer__ DEPAY.TMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISIOM OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS
LOCALITY
FOR APPLICANT T FILL I�I
ADORE
BUILDING
SS NEAREST -
CROSS ST.
LOCALITY L� C DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST S
CROSS ST.
/� RECEIVED BY Ready for Inspection DATEISSUED
OWNER °� �iZJsU
MAIL
ADDRESS v USE ZONE OCCUPANCY MAP
BK PG
CITY TELAO. ri ?
CONTRACTOR 3
CQa.�IISP
ADDRESS ��- Zv' 5-4-4--41 JOB NO.
CITY `G TEL.NO 111 f' TRUNK PERMIT NO.
REGISTRATION NO. �� �b+�-=L a SpAj;Y
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. , STATE ENCROACHMENT
' PERMIT NO.
BLOCK TRACT � X7ry INDUSTRIAL
L/
SIZE OF LOT NO.OF BLDGS. WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS „ P. r r} CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 ✓ RECEIPT N0. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. i 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/ORDRAINFIELD 2.00
STATION DEPTH
CESSPOOL—D RY W ELL
SPECIAL CONDITIONS ONLY 2.00 / / MANHOLE REFERENCE G LOWER
TYPE OF CONNECTION v_LENGTH FROMZs
Ye-
OWNERS PERMIT $ I 00 OURS- P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE L
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF-.............................._.....I9_____ NEW HOUSE SEWER vc- i!
OWNER OR CONNECT ADDITIONAL �F
OWNERS AGENT................ -------. BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS. --------------------------------------- ----------•-•-----•----•------•• AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL ElCATION 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE- = ---- - �-�-. (;_C'_ i.._�V_
76A642D 663 1/53 f