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Home My Public Portal About5117 ROSEVALE DR_Sewer__ C9804 304 APPLICATION FOR PERMIT T6A043D COUNTY OF LOU ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DNISION GUBu1LOlna — / ))DERi A LAMBLE CD1Fmme, AOORE WtLLf/4M A. IMER, Supf of Bulldmq LOCALITY NCAREBT FOR APPLICANT TO FILL IN c.... ST LAL OQ[CRIPIIOM LOT NO J OWNER MAIL / D [LOCK TRACT ADORE MAIL Ho or BL on /f SEE OF LOT NOW ON LOT (/ CITY L NO J BE of BUILDINGS DISTRICT N GAOU/ MAP PROC[ pY �r eK PG f CONTRACTOR ADDRESS CONNECTION DATA CITYT[L NO STATIONet Z DEPTH CTAT[ R[OISTiATIOK N COUNTY MANHOLE REFERENCE - T� No DESCRIPTION OF WORK FRE C X r/ LENGTH F"M HOUSE REWER CONM[CTING TO R L M L TOP L PUBLIC a ER O saw eEPTIc T NK SEEP O[PIT OR PC NO PITS AND/OR DRAINFIRLD slow CO IMP No JSBTO C� d NOUS[SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT MO 0 PRIVATE DISPOSAL BYSTKM O SS GO CONNECT ADOITIO AL AFFIDAVIT RMv[ RA.00T RECORD INSTR NO DAT[ CIC WORK TO HOU[[BRWiR O 42M O OVERFLOW SEEPAGE PIT DAAlNFItLO [LITH CESSPOOL DRYWALL MANHOLE 0 OHM ALTER PAIR AGAHDOH OUS HWY OR R WIDINIMO ,EWER OR DISPOSAL SYSTEM 0 SS GO D. STATKENCROACHMENT H PERMIT PERMIT NO Z INDUSTRIAL ��}�pNERWASTE APPROVAL OWNER'S PERb= f j DO CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEZ 1 HAVE AT THIS DATE A CONTRACT WITH THE XERRIN HAMM CON REIMBURSEMENT rtt TRACTOR ToCONNECT THE ABOVE DESCRIBED [LI"ING DWELLING APPROVALS TO THE PUBLIC B[W[R DAT[ INNECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER ,2 OWNERS AGENT CONNECT ADDITIONAL ADDRESS SU ILDIMG OR WORK I H[R[BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION B[PTIC TANK S[[P PIT(6) AND CTAT[ THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY AMD/OA GRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYW[LL ❑ I HEREBY GRATIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS R[GUIR[D MY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DIBPOSAL SYSTEM CALIFORNIA OR "AT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND A[DIOt IN THE ABOVE CRIB[D R[SID[NTI L PND/[ ABANDON MOUt6 SEWER SIGNATURE OP P611MITT[[ MC KrI LL.[PTHC TAN" ❑ SEEP 'ITIS) LI CESSPOOLS ,T A VA],IDA'P(O ROBERT A WOOD ' (�n -(F'�' 1/`�/f SUPERVISING ROB MECHANICAL ENGINEER I CK Y O CASH I AP- s 9 e etS NDV23 1 0 D 7.00- C L2Dr�fia�,�t/ 5AG4 ID-0[ APPLICA ON FOR PERMIT CESOB I COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING sr r -7 ,>=Yf}��` WMA LAMDIE CSm�Y EBqq�1vvLa ADDRESS �-a WILLIAM A IENSEN 8vP i W Ear ��.1 LG C. LOCALITY NCA IEOT FOR APPLICANT TO FILL IN CROSS ST DEaCRI om LOT NO y� O OWNER O MAIL BLOCK TRACT 3 ADDRESS Aeloq L 6� NO OF SLUGS 612E Of LOT NOW ON LOT CITY/i✓ i(I A,L- %-i—x !L NO Ust BUILDINGS OF NOS SK DISTRICT NO GROUP MAR [SSED BY � /� P CONTRACTOR C) /Yr 0 , - ADDRESS �y*r rZ-1 Y�� :2 7L �2�;j AOXNECTIONDATA If TEL NOA44Z,!�' 1-7q,5 STATION A ¢RT BSTATE MANMOLE P RERENKNC[ UPER REGISTRATION NO COUNTY �_' NO DESCRIPTION OF WORK FEE RC OF COXN[CTIO LENGTH FROM HOUSE SEWER CONNECTING TO CURB P L M L TO P L PUBLIC OMER 0 sow I R C MO d SEPTICTANK SEEPAGE PIT OR C_ -T PITS AND/OR GRAINFIELD O [1000 CO IMP NO �{„)J 1 :� JOB NO O V MOULT ECONNECTING TO TRUNK PERMIT NO I ROAD PERMIT NO DISPOSAL SYS PRIVATE DIpP06wL LYBTIM 0 SSW CONNECT ADDITIONAL BLOO OR AFFIDAVIT RMYIII 945[L[RT RECORD INS" NO DAT¢ W I WORK TO HOUSE SEWER O 53M OVERFLOW SEEPAGE PIT GRAINFIELD EKTN CESSPOOL DRYWELL MA NHOL[Q sew d ALTER R PAIR OR .......USE HWY ORST WIDENING US S[ R DISPO YST[ C SS STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNER'S PEAMIS t z oo CHARGES AIITHORMATION TGTAI FEI �Ay CONNECTION CHARD[FEE I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN MAMSD COX REIMBURSEMENT F[E TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING w�RO" DAT[ INSPECTOR a SIGNATURE TO THE PUBLIC SEWER ALL SIGNED THIS DAV OF 19_ OWNER OR NEW HOUSE SEWER OW N[RS AGE NT C COMN[R ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIP APPLICATION BCPTICTANK SCEP PIT(S) wND/OR GRAINFIELD AN STATE THAT THE ABOVE Ip CORRECT AND AORt¢ TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS RtOULATIMO PLUMBING AND S[W[RS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEW[ROR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF OMAGE DISPOSAL SYSTEM CA LI FORM IA ON THAT I AM THE LEGAL OWNER OF AND INTEND TO OISCOMN[CT PLUDAN p RESIDE IN THE ABOV DESCRIBED n!S TIAL PROPERTY ABANDON NOUS.SEWER •IONATUR. OF FERMI TT¢E BAC KIILL SEPTIC TANKS El PIT(e) ❑ CESSPOOLS AI.IDATION ROBERT A WOOD 1 /�I G1.7 S b•� SUPERVISING MECHANICAL ENGINEER CK M O CASH 1 .two 4 3 3 5" AUC 5 1 0 D 7.00- r.