HomeMy Public PortalAbout5111 ROSEVALE DR_Sewer__ 641
TEBAO- 3 ' APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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WILLIAM A m"EK SMP 1 d HMilm{D J S iv�V � /•a l..
LOCALITY
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DQ/CRIPiION LOT NO ! D OWNER
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CONTRACTOR yT•� /�/�/ / 1 J J
ADDRESS ��/. /� / V/-� ••fF__ CONNECTION DATA
CITY /M.. TEL �JN1jO ON ;O DEPTHA#r1
REGISTRATION NO Y O COUNTY MANHOLE. [R[ C A*1 / R
NO DESCRIPTION OF WORK P H YP[OF ON _ L OTH PROM
HOUSE SEWER CONNECTING TO Y P L L T P L /
PUBLIC SI IRR Y
SIRIC TANK SEEPAGE PIT OR SS°° R C NO ^/ O
RITE AMO/OR ORAINRICLD SIO OO CO IMP NO SMO J u
HOUSE SEWERTEM°TO
PRIVATE DISPOSAL
SYSTEM 33M TRUNK PERMIT NO ROAD PERMIT NO� TT JIM
0
CONNECT ADDITIONAL BLDG OR AFFIDAVIT RYE[[ [Yu[RT RECORD INSTR NO DAT[ O
WORKTO HOUSCSEW[R O 1300 r
OVERFLOW SEEPAGE PIT GRAINFIELD
EETN CESSPOOL DRYW[LL MANHOLE Y SE OO d
ALTER REPAIR OR ABANDON U{[ HWY OR ST WIDENING Z
SEWER OR DISPOSAL SYQTCM m $300 CEN A HMCNT
T
TRIAL
W t AL
OWNER'S PERMIT s
AUTHORIZATION TOTAL FEE �L� CONNECTI N CHARGE FEE
1 HAV! AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EEISTINO DWELLING
TO THE PUBLIC /EWER APPROVALS DAT[ IMSPECTORSBIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OW NEM A°[NT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION B[PTIC TANK SEEP PIT(0)
ANO CTAT[ THAT THE ASOVC I{ CORRECT AND AGREE TO COMPLY AND/OR GRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND ,EWERS CESSPOOL ❑ DRYW[LL ❑
I HERE" CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED A/ REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE L[ L OWNER OF AND IMT[NO TO OISCONNQCT PLUG AND
RESIDE IN TH[ ABOV DESCRIBE CSIO[ AL RROPCRTY
ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TAMNS
OF PERMITTEE BEEP PIT(S) ❑ CEBSPO❑OLB
�AIIDATION ROBERT A WOOD
cK M o CATH SUPERVISING MECHANICAL ENGINEER
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TEAS � APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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CONTRACTOR �17t1-/14-M�^ tea'/ I D� L
ADDRESS ` 0j!F �/ VJ� 04 CONNECTION DATA
CITY TEL NO h 1 J DEPTH A
REGISTRATION NO I L ,3O COUNTY MANHOLE R6og
NO DESCRIPTION OF WORK F[[ rPC F 1 N L[ H FROM /
HOUR[SEWER CONNECTING TO P L M TO P L Y
PUBLIC SEWER d f5 p0 Q
SEPTIC TANK OB[PAO[PIT OR PC NO
ITS ANO/OR DRA INFIELD 0 51000 CO IMP NO ^ J�MO 3 / u
HOUSE SEWER CON SYSTEM
TO TRUNK PERMIT ` �OAD P6 a,
PRIVATE DISPOSAL SYSTEMEM 0 S3 GO V O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVERRA.IA IR RECORD INSTR O DATE
WORK TO HOUSE SEWER O 5800
OVERFLOW SEEPAGE PIT DRAINFI[LD 6
CZTN CESSPOOL DRYW[LL MANHOLE• 55 00
ALTER REPAIR OR ABANDON HOU59 HWY OR ST W NING Z
SEWEDOR DISPOSAL SYSTEM C 5 00 {TATE O M
PERMIT N
NW8TR1 L
WASTE APPROVAL
O CHARGES
PERMIT s z 00
AUTHORIZATION I TOTAL FEEON CONNECTION CHARGE FC[
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN AMBD CREIMBURSEMENT FE[
TRACTOR TO CONNECT THE ABOVE DESCRIBED "PRYING DWELLING
TO THE PUBLIC {EWER AM •O`.
DATE INSPECTOR i SIGNATURE
SIGNED THIS DAY OF IS_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORN
I H[RCBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK S[[P PIT IS)
AND BTATC THAT THC ABOVE I5 CORRECT AND AGREE TO COMPLY AMO/OR DIIAIMFI[LD
WITH ALLCOUNTY ORDINANCES AND STAT[ LAWS REGULATING O
PLUMBING AND SEWERS CESSPOOL ❑ ORYWELL
1 HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OltALTER REPAIR 5CW[R OR
LICENSED AS REQUIRED BY LOS "PR
COUNTY AND STATE OF BEWAOE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INT[XD O DISCONNECT PLUG AND
REBIO6 IN THE ASOV O[SCRI BE R[SI TIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE
OF FERMI TT[[ SAC KVILLSEP6TANKG ❑
BEEP PIT(G) LI CESSPOOLS
VALIDATION ROBERT A WOOD
cN M D CASH SUPERVISING MECHANICAL ENGINEER
4 4 2 1F, MG 6 1 0 D 7.00"