HomeMy Public PortalAbout9214 ROSEGLEN ST_Sewer__r .
APPLICATION FOR PERMIT 1
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DIVISION OF SUMDUM AND SAFETY SEWER—SEWAGE DISPOSAL
DRpmftRnt of Co—tr EnOuaw Q
Co Of � �si~ BUILDING
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WM.J.FOX. COUNTY 6NOLNm!
`',m•Tr D.GRIFFIN,Our T or RummDIo tVAAt
LOCALITY emple City
FOR APPMCANT TO FILL IN "Lp"S it
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LEGAL
DESCRIPTION LOT X0. 10 OW11ER Jack Weber
BLOC[ TRACT 210pi ADIDRm `l% O. San Gabriel Blvd
NO. OF BLD6E. n
SIZE OF LOT NOW ON LOT G C TEL. NO.
UDE OF
DI Residence
UILD GDBI3TRICT X0. GROUP YAP
CONTRACTORL. D. & fid. CONSTHIICTION �' �— _ PG
ADDRESS �T /y�/� GONION DATA
CITY (�piI], TEL NO. J}IL 8 3\JI 4 6TA710N -�6 DEPTH
❑ STATE YAMH0LE REFERENCE UPPE
REGISTRATION NO. 11 0
no. DESCRIPTION OF WORK FEE
TYPE OF CONNEGTIO LENGTH FROM
HOUS SEWER CONN[CTMG TO Y. CURB L Y L TO P, O
PUBLI SEWER 3.60
HOUSE SEWER CpNNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR CO IMP. N0. P�+.iA�-NAr ,
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EX19TING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCpNXECT AND ABANDON SEWER
/ PENCROACHYE?IT
� AND OR DISPO3A SYSTEM 1.00 pERMSBS1Y1T NO.
4 SEPTIC TANK,SEEPAGE PITOR
PITS AND/OR DRAINFIELD .00 INDUSTRIAL
CESSPOOL-DRYWELL WASTR APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OVnew$ PEMT S 1 00 CONNECTION CHARGE FEE
AUMORIZATION TOM FEE 050 REfYBUPSENENT FTE
TRACTORTTOSDATE CON ECT THEA`CTED WITH THE ABOVE DESCRIBED UnING VIVELLIEREIN NAMED NG APPEOVALS DATE INSP 0 ' RNA TUR[
TO THE PUBLIC SEWER
SIGNED THISAY OF 19-
fNER OR NEW HOUSE SEWER
OeY CONNECT ADDITIONAL
OWNER[ AGENT BUILDING OR WORK
SEPTIC TANK,LEEP, PIT(1)
ADDRR� AND/OR DRAINFIELD
I HEREBY l�C"CWLEDGK THAT 1 HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
AND STAT[ THAT THE A9OVE 13 CORRECT AND AGREE TO COMPLY
WIT4 ALL COUNTY ORDINANCES AND STATS LAVES REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEM EAS. SEWRE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICENSED X18 REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AY THE LEGAL OY ER. OF TUR ABOV[ ABANDON HOUSE SEWER
DESCRISRD REZIDRRTIAJ. PROP DACIIFILLSE CTM KS❑
S IT f POOV
SIGNATURE
OF PERMITTEE
Wll L feu J.FOX.COUNTY SNa1Nitme viumAnom R.A.WOOD. Ctilxr PL.". INRp[r1:TQR
M2 1 3 7:i MR19 4 A 4.5 0