HomeMy Public PortalAbout10661 ROSEGLEN ST_Sewer__ DEPART OF OOUNTY ENGINE= SEWER—SEWAGE DISPOSAL 7
DIVISION OF BUMI)ING AND SAFETY PERMIT APPLICATION 1
06UNW OF LOS ANGELES
WILLIAM J. FCX, COUNTY ENDIN[IR BUILDING
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ADDRESS 404 �I CAOBUILDING 7-U A-Dra,
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LOCALITY DISTRICT M0. SERIAL NO. PERMIT NIL
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OWNER RE IVHq Ready dy flar� w tiDATE ISSUED
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CITY TELMO. TRUNK PERMIT M0. �-
REGISTRATION N0. /�� ��� �� STATE ROAD PERMIT NO. \
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT M0.
BLOCK TRACT INDUSTRIAL
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SIZE OF LOT M0.SF 0L 4S. WASTES APPROVAL
NOW ON LOT CHARGE
USE OF
BUILDINGS E �,}1 - CONNECTION CHARGE FEE
NO. DESCRIPTION OF WnRK FEE
HOUSE SEWER OONMECTI TD REIMBURSEMENT FEE
PUBL_IO BE-WEB 7461 RECEIPT NO. BY
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PRIVATE DISPOSAL SYSTEM IJM
CONNECT ADDITIONAL WORK TO HOUSE SEWER L OR 1.10 EXCEPTION RE ED
H OR R"-ATR bd M MO• VT
E BY
SEWER OR DISPOSAL SYSTEM IJM
DISCONNECT AND ABANDON SEINER
AND/OR DISPOSAL SYSTEM 1.01 CONNECTION DATA
&EP'nO TAN
FITS AMD ORDBAIMFIELD LtMI
0 LL STATION f��, d DEPTH
BrECIAL CONDITIONS ONLY 2-00 ! MHOLE REFERENCE
V UPPER xqwul
TYPE OF CONNE ION LENGTH FROM /
CURB_ P.L. N.L.TO P.L. 1- S
OWNERS PERMR ; I o0
AWHOR ZATION I TOTAL FEE c
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS IMSPtiOTOR'SSIGMATUBH DATE
DWELLING TO THE PUBLIO SEWED
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK BEEP.PIT(S)
AND/OR DRA .FIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATIONAMD STATE THAT THE ABOVE IS 00RREOT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND iEWERG SEWAdE DISPOISAL SYSTEM
1 HEREBY DERTIFY THAT I AM PROPERLY REGISTERED MECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDISOONOM HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. IMOKITILL SEPTIC TANKS
SIGNATURE ❑
iEEP.PIT(S)❑ CESSPOOLS❑
OF PERMITTE
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