HomeMy Public PortalAbout9203 ROSEGLEN ST_Sewer__ 76A&"° APPLICATJON FOR PERMIT _
DIVISION OF BUILDING AND SAFETY SEWER EWAGE D 1 S POSH L
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C-= 7 of " Anoolm f7m
ING 9203 8oseglen street
BS
VM.-1.Fox, COUKW T OF M'r� ample City
CAftATT D.aR[ #Lrr T or ssTusD,a
FOR APPLICANT TO M IN R Encitas
LZQDESCRIPTION LOT No. 1 OvAlIm J
— ack Weber
BLOCK TRACT2400 ' An RESS 272 3z So, Bern Gabriel B1 do
SIZE OF LOT ROW ON LOTGS' 1 c(TY Be Gabriel
TIL fl O.
USE OF
UI IROS DIfTBICT 0. CROUP YAP
CONTRACTOR L. D. & M. CONSTRUCTION 1PZ .
ADDRESS P•0• ,aaBo�= 208 . . C0X?U CT'= DATA
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CITY Baldwin • TEL. No. ED $ 024 STATION -f- . IDEPTH
MANHOLE REFER NCR PPiR
REGISTRATION No.
113613lay-
L
No. DESCRIPTION OF WORK Fn
TYPE OF CONNECT LENGTH FROM
OUSE SEVER C X ECTIXG TO Y CURB' P.L. Y.L TO P.L.
UBUC SEWER 3.56 Lso -4
HOUSES ER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
NNECT AD TTIONAL BLDG. OR CO. IVP. N0. P.
C. m0.
0. �
WORK TO HOUSE SEW 1.00
ALTER OR REPAIR I>iT X4
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO,
DISCONNECT ANQ ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.06 PERMIT NO.
SEPTIC TK,SEEPAGE PIT OR 1NDUSTAIAL
PITS AND OR DRAINFIELD .00 APP OVAL
CESSPOOL- QRY-WELL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARCE FEE
OWNEE'S PEUM $ 100
AUTHORIZATION TOTAL FEE 50 REIMBURSEMENT FEE
I HAVE HIS DA'T�HH LO!fT�A CC77ED WITH HE HER I��11 !!{(AYED CON-
TRgCTOR TO ECT
THS A90YE D(iSCRIBEQ PI�STIXO DWELLING APPROVALS DATE I-IIjF TUBS
TO THE PUBLIC SLIVER
SIGNED THIS SAY OF 1S PJFV HOUSE SEWER
OWNER ORCORRECT ADDITIOVI,
OWNERS AGENT New BUILDING OR WORK
SEPTIC TANK,SCMP,-PLT(S)
ADDRES'S AND/OR DRAINFIELD
I HEREBY ACKN LC//D11 E THAT 4 HAVE RJ"iApD THIS
APPLICTO ATION CESSPOOL❑ DRYWELL❑
MPLY
WITH ALAND L COUTTHE Mf} OkD1NANCHSBOVE 19 ANDECT STATE U1W1 REGULATIX-0
PLUYBIHG AND SiWERS. ALT�i REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR S4UdE DISPOSAL SYSTEM
LLCENSED AS REOUIRED BY LOS ANGELES COUM!(TY AND STATE OF D18COMMECT PLUG AND
CALIFORNIA OR THAT 1 Al THE LEGAL 01NXF3 OF THE ABOY$ ABANDON'HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY, d/(CIF1L1 C TANKS❑
\ 112EP.PITS CEIIS POOLS
010IRURE
OF PPER "'4' ��j
WILL-AM J.FOX,Courier ENGLKKVC VALm=ON R.A.WOOD.CHInr FL". u1*rs)croR
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