HomeMy Public PortalAbout9202 ROSEGLEN ST_Sewer__ .;'"w;,3-.. APPLICATION FOR PERMIT
DIVMQN OF BUILDING AND SAFETY SEW E EWAG E D 1 SPOSA L
D.y� of CQ=fy Emahmw
C .tr of Los Augalm SUTLDING
VM-J. FOX. COUNTY EHGINmt ADDRESS
CIAMUATT a GRIFF'M,Sup T or■unmmo . LOCALM Temple City
FOR APPLICANT TO Fal IN N�,TT EIIcita6
DESMF7ION LOT NO. OXER Jack Weber /+
BLOCK TRACT 2`I021 MAILADDRESS SCT ji
SIZE OF OT NOW ON OTNO. OF s 1 CITY$Bn .Babfiel TEL. NO.
USEOF Residence
B IN DLMICT R0. GROUP YAP
CONTRACTOR L.1)• M. UONSTRUCTION C s PZ .
ADDRESS R.O. Box 208 CODON DATA
CITY Bald ParkEL. NO. $D 8 .3024 STATION S-g DEPTH
fC, ❑ YAM HOLE RIFER EX C! _ L
UPP
TR
REGISATION N0. 7361
No. DESCRIPTION OF WORK F>s
HOUSE SEWER CONNECTING TO TYPE OF COXNECT70 LENGTH FROM
T CURB Y L. TO P.L.
PUBLIC SEWER 7,60
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 1.00 CO IMP. NO
ALTER OR REPAIR EZI'}TING TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER OR DISPOSAL S BTEY 1.00
DISCONNECT MD ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR INDUSTRIAL
PITS AND/OR DRAINFIELD .QLD
CESSPOOL-DRYWIELL WASTE PPROVAL
SPECIAL CONDITIONS ONLY 2.100 CHARGES
ovnurS PffiCT E 1 Otl CONNKCTIOX CHARGE FEE
AUTHORTLATION ri&ULL FEE REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- '
TRACTOR TO CONNECT THE ABOVE DESCRIBED )PcISTINO OWEI,LING MPROVAU DATr l S'SSIGNATURR
TO THE PUBLIC SEVER
SIGNED THIS SAY OF 19 NEW HOUSE SEWER I
OWNER
ERS AGENT New BUILDING ORNECT WORKOWN
SEPT)C TANK,8EEP, PIT(2)
ADDRESS AND OR DRAINFIELD
1 HEREBY ACKNO�ILEDGE THAT 1 HAV[ READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE TT��{{AAT THE ASOYE IS CORRECT AND AGREE TO COYPU
WITH ALL CbUXTY ORDINANCES AND STATK LAWS REGULATING ALTER, RIPAIR,SEWER OR
PLUMBING AlD SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I Al PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUiRED DY Os ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AY THE LEGAL OWJJ OF ABOWE DON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPER ! ACKFILLCTM KS
1 S IT D CESS%ol
S I G MATURE
OF PERYI
WI!uAm J.FOX.COUNTY rLNo mm YALMA71ON R.A.WOOD,CHIKF PL,a. IN"ECrOR
212923 MAR 19 4 A 4.50 %R