HomeMy Public PortalAbout10657 ROSEGLEN ST_Sewer__ D>PAIM[ENT OF COUNTY IIVGINIMM SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTX. OF I.4D8 ANGEL BUILDING ,C-
WILLIAM J. FOX, COUNTY ENGINE" ADDRESS D W J
FOR APPLICANT TO RLL IN LOCALITY
BUILDING ADDRESS 10667 EC®o Gell St. ORMIT.
LOCALITY T®nle Ci t0 DISTWOT MC. SEiIAL NO. PERMIT NO.
NERO>%EST. Bl Hoot a Ave. A 6-1-1, --<zS
IUM BY Baty tr Ia.'..tl.a DATE ISSUED
OWNER P.L. Mo Nutt _ /6
MAIL
-ADDRESS 272- Sall Gabriel Blvd. USE ZONE OCCUPANCY MAPPG-
CITY cnn rphri l A TEL-NO- QT 94264 /
CONTRACTOR L.D. & H. Constr. Co. ,, O C
ADDRESS 21 W. Wisturis Ave.
JOB No. 6 �5—
CITY greadia TELMO. Do 62238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 0 42 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT M0. 63 PERMIT MIX
BLOCK TRACT 19169 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT M0.OF BD
MOW ON LO CHARGES
OF
BUI!DINGS Res, CSG Garage CONNECTION CHARGE FEE
NO. DEBCRIPTION OF WORK FEE
REIMBURSEYlNT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER i 8-30 RECEIPT NO. DA BY
PRIVATE DISPOSAL SYSTEM O 1.01
CONNEOT A (TION BL S EXCEPTION ORDED
WORK TO HOUSE SEWER Im
ALTER ER kEPAIfk ItXlel-N4- ND TiY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND AfiANDON GEWER
AND/OR DISPOSAL SYSTEM 1.W CONNECTION DATA
SEPTIC TAN ,
PITS AMD ORORAINFIELD 2-M STATION DEPTH G /
CESSP --0RYWELL
SPECIAL CONDITIONS ONLY LSO s' M MHPPEREFERENCE
TYPE OF OONN! M v LENGTH BOM
OWNERS PERmrT $ I 00 +8' P.L M.L TO PF
AUTHORIZATION I TOTAL FEE A 60
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEOTO"BIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19— NEW HOUSE$&WEB S G a-
OWNHR OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRA MFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[ ORYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER flEPA1R SEWER OR
REGULATING PLUMBING AND SEWERS. BEWA�E DISPO�JIL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AMD/OB LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
EB OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. °TANK ❑
SEEP.PIT(S)CI CESSPOOLS
OFIP�EBMIIrm. L.D. & M. CONSTR. CO.