HomeMy Public PortalAbout9222 ROSEGLEN ST_Sewer__=te "°
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APPLICATION FOR PERMIT
DriMON OF BMMING AND SAFETY SEWER—SEWAGE DISPOSAL
Dsparb"=t of Coan#r ElaQfasMe
Conray of Las Aall bs BUILDING
W9222 ROSAIZIAn ki
M.J. FOX,Coumw"clit�e
CA90ATT 0.DIRLFFIN,swT oR NrummUte LOCALIrT Temple City
FOR APPLICANT TO FRI IN NEAREST Encit"
LEGAL
DESCRIPT70M LOT MO. 12 OWNU
BLOCK TRACT 24021 , ANAILDD L(L /` 0 an gabr 01 �lvd
MO. OF BLDG9.
SIZE OF LOT NOV IT
ON LOT 1 CY BII TEL. NO.
USE OF Residenee
BUILDINGS DISTRICT NO. GROUP YAP
CONTRACTOR L. D. & fid. COASTH[TOTIOB '- Z
ADDRESS PX. Boa 208 r�,1 COMME ION DATA
CITY Baldwin P$ Tx,- ,o;MD 8 3024 STATIOM,,g DEPTH
.. ❑ STATE MANHOLE REFERENCE U PER �-
REGIrrRAt1oM NO. 113613
NO. DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO TYPE OF CONN[ L.HMGTH FROM
PUBLIC SEVER I 3.50 3�50
T CURB P. Y L. TO P.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. QR
WORK TO HOUSE SEWER 1.00 CO IMP. NO �+fti-MCS
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER fTAT�ENCROACHMENT
AND/OR DISPOSAL SYMN 1.00 p YIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 46010 INDUSTRIAL
CESSPOOL-DRYWHLL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FKE
OWNER'S. PEBMIT $ 1 00
AUTHORIZATION TOTAL FEF REINBURSSYENT FEE
1 HAVE THIS DATE LONTRACTED WITH THE HEREIN NAMED CON- =�D
TRACTOR TO CONNECT THE ABOVE DESCRIBED EQI$rTING DWEUJNQ APPROVALS DATE INSPECTIGNATUR!
TO THE PUBLIC 9EWSIR
SIGNED THIS DAY OF 19- NEW HOUSE SEWER
OW4ff�I OR 11e� CONLDI 0 OR ORKNECT AL
oWME$S AGENT
SSEEPpTTIC TANK,BEEP,PIT(S)
ADDRFSt AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CnSPOOL[:1DRYRELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE.? AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUYBIND AND SEWERN. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICEN ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AY THE LEGAL 0 NEE OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. SACILy 1C TANKS
SEEP. IT
S CESSPOO
SIGNATURE _
OF PERM
WILLIAM J.FOX,CouNrY F.N61NImi VM.WA7= ' M A.WOOD.CxIM>PL&Q. tuwm)ITOR
' AP-2159fR MAR19 4 A 4.5 0