HomeMy Public PortalAbout5703 ROWLAND AVE_Sewer__ Tem—, le City
6A 642D -CE808-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER �ry
BUILDING AND SAFETY DIVISION ADDREIss 51 0✓ i�T. : vYlaY]d Ave_.
LOCALITY �'elnple City
FOR APPLICANT TO FILL IN CROSSSST. live Cay Ave.
_LEGAL
ESCN -
�DRIPTIOLOTNO. OWNER Lawrencellto-
MAIL
BLOCK TRACT ADDRESS 5703 j1j• Rowland
Ave ..
_ fOF BLOGS. ;;T7 11
SIZE OF LOT 15, .5.1;/j.d u f�;l x tyOW ON LOT 2 CITTem- le C i t i T.L. NO. 28 5-6 9 V
USE OF Res. r ("1
BUILDINGS Gar. DISTRICT NO_ GROUP I MAPOC SSED BY
BK PS
GONTRACTORr.,Jquare Deal Sewer Service �}aa!� > i f
ADDRESS 2933Maxson Rd. CONNECTION DATA
CITY El Monte TEL. NO.
444-2020 STATION. Y-f- DEPTH
STATE O Q ('� LIC I^I I� MANHOLE REFERENCE4; ) =� ,yUPPER
LICENSE N.
8870 GLASSY-�^Y
NO. DESCRIPTION OF WORK FEE TYPE OFC.TION LENGTH FROM
'I HOUSE SEWER CONNECTING TO rr (�/n� Y. CURB - P.L. M.L.TO P.L.
+. PUBLIC SEWER 0 $7.00 00 Y -
SEPTIC FANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. T;3 JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00 f O
- CONNECT ADDITIONAL BLDG6�, AFFIDAVIT W.IVEII EASEMENT RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER j_A__$�3.00 3 00
OVERFLOW SEEPAGE PIT,DRAINFIEL4
EXTN..CESSPOOL.DRYWELL, 0 $5.00 0
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING y a J .-�� _ f f
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
MANHOLE 0 $7.00 PERMIT NO.
-- INDUSTRIAL
WASTE APPROVAL Z
OWNERS PERMIT $ 3 00 CHARGES
AUTHORIZATION1 TOTAL FEE , 3 CC CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CON
TO TNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
HE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT-- CONNECT ADDITIONAL
ADDRESS_
BUILDING OR WORK
-
- SEPTIC TANK.SEEP,PIT(S) ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL Cl �-1 DRYWELL 4
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM TME LEGAL OWNER OF. NO INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDENTIALOPE TY. ABANDON HOUSESEWER
SIGNATURE 7
_ .__ BACKFILL
OF PERMITTEESERFiGr-"P'ANKS"°�J _
-_. j _ _-. SEEP_.'aPiTfS)�•., POOLS �
VALIDATION CK. M.0. CASH
n 0 2 6r=JUN �--5 1 3, t A�i-j
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