HomeMy Public PortalAbout10656 ROSEGLEN ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
FOR APPLICANT TO, FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 6-+
CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
s
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
BK PG
CITYTEL.NO. 6
CONTRACTO � �
�=i_ , CO�tMa u0
ADDRESS�j_ A� w�- �i Cµ JOB NO.
CITY 22222501__ 1,I L / TTELL..NOO.. /',Q TRUNK PERMIT NO.
REGISTRATION NO. /��� ��' �� �}�
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT ��/�/ 9 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER Q $ 3.50 RECEIPT NO. DATE I 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 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
+R LOWER
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT 1 00
'
Y. CURB P.L.__ M.L.TO P.L.
;
AUTHORIZATION TOTAL FEE ,41y
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........................................19..__._. NEW HOUSE SEWERT-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------------------------------------------------------_.-. BUILDING OR WORK
ADDRESS-------------- SEPTIC TANK,SEEP.PIT(S)
-...._ - _.........- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
R LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
AND/ODISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS❑
SIGNATURE • tj_ + SEEP.PIT(S) CESSPOOLS
OF PERMITTEE. -.__- i�
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