HomeMy Public PortalAbout9215 ROSEGLEN ST_Sewer__ APPLICATION _ FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER SEWAGE D I SPOSA L
Daparftment ofEnallnow
County County
FNU ° 1 Roselen StreetWM.J. FOX,COUNTY GNalNlml4CUUMATT D.CIFU IN,StlrT or Wutuwme Y T CltmFOH APPLICANT 1 O FILL IN Q i t g e
DESCRPTION LOT NO. 3 O"ER Jack Weber
BLOCK TRACT `ADL 2 do Ben b,-lal Blvd
ADDRESS
SIZE OR LOT NOW ON LOTNO. OF BLDS CITY S&n GaLbrie 1 TEL..NO.
USE OF
BUILD DISTRICT!(O. GROUP LAP
CONTRACTOR _ r.C)MTRUCrPT0Nr���pp _f��i''""'
ADDRESS P.O. Box200 COMC=ON DATA
C n _ TEL. N0JjW. a 3024 STATION '� DEPTH
REGISTRATION NO. 113613x BANHOLE REFERENCE
OW
No. DESCRIPTION OF WORK FEE
HOUSH SEWER CONNECTING TO TYPE OF CONNECTIO LENGTH FROM f
PUBLIC SEWER 3.50 T. CURB Y L TO P.L
HOUSE SE7r8R CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CON NGCT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER 1.00 CO. IVP NO i6D-lf9r
ALTER OR REPAIRSYS`TE TRUNK PERMIT NO. ROAD PERMIT NO.
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
I AND/OR DISPOSAL SYSTEM 1.00 STATE ENCROACHMENT
PERMIT N0.
i SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNEH'S PERMT
j 1 00 CONNECTION CHARGE FEN;
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE H19 DATE TRACTORTTOCONNECT CONTRA
ABOVE DESC BEDCTED WITH THEHEXISTINGAQWELUMQ AHOYALS DATE INSP QYATURK
TO THE PUBLIC SEWER
SIGNED THIS� AY OF j9 NEW HOUSE SEWER 4,
OWNER OR lye* CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
EHPTIC TAX K,SEEP, PIT(9)
ADDRF�• Q LEp AIID/oR DRAINFIELD
AND STATE ACXXQW PGpEEYTHAT CORRECT AND AGRETHIS APPLICATION
CATION CE POOL❑ DRYWELL a
WITH ALL COUNTY ORDtNANC95 AND STATE LAMS RiGULATING ALI R�AIR,SEWER OR
PLUMBING AND SEWERS. SV*AGE ISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY' LOS ANGELES COUNTY AND S'TATK OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AN THE LSG ER OF THR ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL C TANKS Q
•' SEEP PITS CESSPOOLS
El
SIGNATURE
OF PFR I
WILLIAM J. FOX,CoumTY ENatnVALMTjON R.A.WOOD.CHIf-1101. lKZPV TORI
7
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LAW
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