HomeMy Public PortalAbout9219 ROSEGLEN ST_Sewer__ APPLICATION FOR PERMIT
4•Dr4=0N OF BUILDING AND SAFM SEW E EWAG E DISPOSAL
of Cc-mly Engh~
Cammiy of Los A gel" BUILDING
ADDRESS St-PAA
WM.J.FOX.Coumw SNCITNmm
CA@*ATT D.GRIFFIN,Suri or tuummm LOCALITY Temple City
FOR APPLICANT TO FILL INVT. zimit J4 ft
REAR EST
DESCRIPTION LOT NO. t} _ OIrnYR Jack Weber
BLOCK TRACT 24021 MAI L
ADDRESS )fiSo B
NO. OF BL CITY Ban Gabriel THS. X0.
SIZE OF LOT NOW ON LOTT 2 G
USEOF
OUILDIIGS DISTRICT NO. GROUP YAP
rG
CONTRACTOR _z— Z
ION
ADDRESS P.O. bog 2>08 CONNECriON DATA
ClrlBP TEL. no. 3024 STATION DEPTH
REGISTRATION NO. 113613 [I STATE� uUP
NHOLE REFERENCE
no. DESCRIPTION OF WORK FEe
HOUSE SEWER CONNECTING TO TYPE OF COXXECTIP LENGTH FROM /
PUBLIC SEWER 5.60 Y. CURB Y.L. TO r.L
HOUSE SEWER CO"ECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. N0. ��
WORI TO HOUSE SEWER 1.00 Co. IMP. NO
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNE AND"ANDON SEWERSTATfi ENCROACHMIENT
AND/OR DISPOSAL SYSTEM 1.00 P MIT NO.
SEPTIC TAnIC,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNES'S PSHIQT f 1 00
AUTHORIZATION TOTAL M 4�50 REIMBURSEMENT FEE
I HA H1MED COX-
TRACTORTTOSCONNECT TDATE HEA
ABOVE CTED wDESCR BEDITH THE HEXISTINGEREIN ADWELLING APPROVALS DATE INSPECTOR' NATURR
TO THE PUBLIC SEWER
SIGNED THIS SAY OF 19— NEW HOUSE SEWER r
OR ER OR CONNECT ADDITIONAL
OWNERS AGENT �e* BUILDING OR WORK
ADDRF�t SEPT C TAMC,SEEP.f[T(S)
1� AIID OR DPAINFIELD
AN�HEREBY STATE 7HA��6BBE¢YE 1 T CORRECT AND AGREEATOLCOMPOLY CER POOL❑ DRYLELL❑
MI H ALL COUNTY ORDINANCES AND STATE LAMS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SMAOE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AY THE LEGAL OF THE BOY[ ABANDON HOUSE SEWER
DE9CRIBfiD RESIDENTIAL PROPQITY. BACIFILLC'(• us El .
8i�8P PlT 9 CHBSPOOLS
SIGNATURE
OF PERM
WILLLAM J.FOX.Coutm FNGLN YALED&TION R.A.WOOD, CHIEF Pum. INSr[GTOR
M21. 32gt X19 4 'A 450