HomeMy Public PortalAbout9232 ROSEGLEN ST_Sewer__ APPLICATION FOR PERMIT
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1>1111 ION OF BUrLDING AND SAFETY SEWER----SEWAGE DISPOSAL
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JOHN M Eof LCou�rrQrY GINEErt ADD�REDeG 2 BOBe len btireeti
m CABSATT 0. GRIFFIN, SUPT Or BUILDING LOCALITY temple ► _
NtAKM
FOR APPLICANT TO FILL IN Ckoss ST.
LEGAL l� OTHER DESCAIPt10n LOT N0. -
BLOCK TRACT 24021 MAIL ADDRESS
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ADSDREDa V
NO.OF BLDBS. A ci-gam Gabriel TEL. X0.
SIZE OF LO NOT ON LOT 2
USE bF
BUfLDIXGd Beigide=e
DISTRICT NO. GROUP MAY ps
CONTRACTOR L.D. & M. CONSTRUCTION-
ADDRESS � � o=
P O B 208 CONN=ON DATA
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aTAT10h v DErTH
CITY Pk 'EEL XO-
11A71dOLH QEFEREIICE-'- A UPPER
❑ STATE OW
REGISTRATION No. 113613
No, DESCRIPTION OF WORK FEE
buaE 8 ER COn CTING TO TYPE OF CtlNNECTIO LENGTH FRO
T. CURB L. .L_TO P.L.
PUBLIC EW e s S.SO
SEPTIC TANK,SEEPAGE PIT OR
ITS AND/OR
XD/O D INFIELD Q 13.0-0
OVEknOW SEgPAgBPIT.DRAINFIEI,.D P. C. NO.
ERN„CESSPOOL DRYWELLMANHOLE s 2.00 CO, IVP. no. .Ji1rAGi
HOUSEfrEPR CONNECTING TO
PRIM 6, SAL SY.STE 4 t.00 TRUX PERP O. ROAD PERMIT N0,
CORK EGT ADDITIONAL BLDG,OR STATE ENC.HOACHYEXT
WORK"r, HOUSE SEWER f 1.00 PERMIT 0.
ALTER,R$PAtR OR ABANDON HOUSE- ry1DllJJATRIAL
I 3 OQ D1aPOSAL >TI Y - @ 1.00 WASTE APPROVAL - - -
CHARGES
CONNECTION CHARGE FEE
ovaTMIS PERMIT t 00
A=OEYZATION TOTAL. FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN WED CON- APPEOVAW DATE INS OR'SSIGNATURE
TRACTOR TO CONXE�T THE ABOVE DtSCRIBED EXISTING DWELLING
TO THE PUBLIC $EWER. NEW HOUSE SEWER !
SIGNED THIS hAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWItERS AIGEhT �'= SEPTFCTA11K,SEEP,PIT(a)
ADDRESS AND/OR DRAINFIELD
I HFREBX ACKNOWLEDGE THAT I HAYE READ THIS APPLICATION CESSPOOL❑ DRY-WE”❑
AND STATE THAT THEABOYE I3 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALtYR,RSTAIFt,SEWER OR '
PLUMBING AND SEWERS. AGE DISPOSAL SYSTEM
I HEREBY CE7tTIFY THAT I AY PROPERLY RIGISTERE.D "D/OR
LICEN& AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON
DISCONNECT PLUG AND
CALIFORNIA OR THAT I AY THE LEGAL ER Or THE ABOVE ABANDOn HOU$ SEWN
DESCRIAED RESIDE AL PAPP RTY. BACLP'ILL SEPTICTAmKs❑
SIGNATURE
+ SEEP.PIT($) ❑ CESSPOOLS d
OF PERMITTE
JOHN A. �. BIF;�. CouNTY E,NQINkEtR VAL DATION ROBERT A.WOOD,CHIEF PLBO. INIPECTOR
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