HomeMy Public PortalAbout9208 ROSEGLEN ST_Sewer__ —lek"ZD APPLICATION FOR PERMIT
MIME OF BUMDINC AND SAFETY SEWER—SEWAGE DISPOSAL
D.y�.at of Cammi7 Emobu ;
Co�7 of ra A Q*ko R° ° 208 Regie ®n Street
WM.J.FOX, Couwry U.Naiwmt Temple
17 /�
C�.MATT D.GRIMM,•Ur-r 0r WuubDW LCALITT Tem Y e Ci
FO APPM 1O FILL IN "oE0 w�
DESCRIPTION LOT NO. 5 OWNER Jack Weber
BLOC[ TkACT x4021 ADDRESS $ B G � 1
SIZE OF LOT NOW ON LOT'' CITY San GabT 81 TEL.AO.
BUILDINGS
DI Residence
B LINOS DISTRICT NO. GROUP YAP
cowrR-AcTok Z. D. & M. CONSTRUCTION � Ra
ADDRESS /� CONNECTION DATA
CITY-bald Fk TEL. NO. IM 8 3u24 STATION �"' DEPTH .
z MANHOLE REFERENCE UPPER
REGISTRATION No. 113613
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO Y TYPE CURBNNE P Y L. FROM
PUBUC SEW-ER 4 .3.50
kk{{OUSE SEWER CONNECTING TO
PRIVATE DISPOSAL EYSTPM 1.00
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER 1.00 CO ILP NO.
ALTER OR REP/IR EXISTINNG
SEWER4OR DISPOSAL SYS TlM 1.00 TRUNK PERMIT 140. ROAD PERMIT NO,
DISCONNECT ANDAMDpN SEWER STAT EHCRQACHME)rT
R '
AND/ODIA OSAL E STE 1.00 PERMIT NO.
iEPTIC TANK, 9 EPAGE PIT 0
PITS
All(
BRAINFIELD .00 INDUSTRIAL
CESSPOOL,-ppR RMI
■ PP OV L
SPECIAL CONDITION8 ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNEWS PE$ICT s 1 00
AOMO=ATION TWAL FM 4 •REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE H EIN NAMED M-
TRACTOR TO CONNECT THE ABOVE'DESCRIBED I LNG DW I A$PHOVALS DATE MSP I9NATURI
TO THF PUBLIC SEWER
NEW HOUSE SEWER
pSIGNED THI$ SAY OF 19- 11
ONOWNEAf AGENT Now BUILDICT NG OR WORKAL
ADD@ESP SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINF ELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION FEbSP00L Q DRYWEL,L❑
AND STATE THATH� ABOVE IE CORRECT AND AGREE TO COMPLY
WITH ALL COUNT oRD111ANCES AND STATE LAWS REGULATING ALTER,RERAIR,.SEWER OR
PLUMBING AND SEWM;S. SEIfAOE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
f,iCEED AS REQUIRED BY L
S ANGELES -COUNTY AILD STATE OF DISCONNECT PLUG AND
CAtIFONSRXi^ -Opp THAT 1 AN THE LEGAL Kit OF THE "KYR AEANDOY HOUSE SEWER
Dr0CRIBEP R21DENTIAL PROPER BACKFILL 811' C TANKS o
• PIT E IMPOOLf CI
s1aluTUlea
OF PIMM
WILLIAM J.FOX.CouriTY EmaLNKmY VAt•H)aTE?j+I EL A.WOOD. CrH[I'IRsd. INarctiOR
1 02-1 3 6m MR 19 4 a 4.50 2