HomeMy Public PortalAbout5707 ROWLAND AVE_Sewer__ 1�
P DISPOSAL
APPLIGATI�N FOR PERMITAGE Dos ,
78A842D
GEsos COUNTY OF LOS ANGELES
OF BUILDING
COUNTY ENGINEER
_� -----
DEPARTMENT SAFETY DIVISION ADDRESS _-----
BUILDING AND --—
-------- --
IE, County Eaginees LOCALITY
CASS1{TT D• IFFIN, Sup t of Suildia9
NEAREST _
GROSS S
FOR APPLICANT TO FILL. IN — --- _-
OWNED—
-__-_---- MAIL
LEGALLOT NO. - ADDRESS __e _._
DESCRIPTION TEL.N0.
TRACT CITY - MAP I
BLOCK NO.OF BLDGS. j 4
NOW ON LOT GROUP BK P'
-. DISTRICT ND. I _ .
USE OF
BUILDjraG.s CONI3ECTION DATP' — -
CONTRA ,.. �' DEPTH
—_ a:
STATION�.
ADDRESS
-' TEL.NO. MANHOLE REFERENCE
[7 STATE
CITY COUNTY
`Rp RA710N N� —_ FEE LENGTH FROM l
N0.I DESCRIPTION OF WORK `�` T�CONNECTIONP L M.L.TOP L
HOUSE SEW ER
CONNECTING TO @ $3.50 CURB
PUBLIC SEWYRSEEPAGE P_IT OR @ $3,00
SEPTIC TANK, P,C.NO.
PITS AND/OR ORAL T DRAINFIELD JOB NO_
OVERFLOW SDEPA F MANHOLE L- $2.00
EXTN..CESSPOOL,DRYV1_LL_ CO,�MP_ Nom•_
HOUSE SEW R CONE NECTING TO �. $1 DO ROAD PERMIT N0.
PRIVATE DISPOSAL L.SYSTEM TRUNK PERMIT N0. --
$1.00 -.-.--_'�-----
CONNECT AOADDITIONAL BLDG-ORSTATE ENCROACHMENT --
WORK TO HDU SE SEWER_"- ----�— PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE @ $1,00 _
SEWERDISPOSAL SY51EM 1N DUSTRIAL
WASTE APPROVAL CHARGES RGE_S -__�-----�—
CONNECTIO��EE
PERMIT
OWNER`S ----� REIMeuRSEMENT Fe>
� DATE INSPECTOR'S SIGNATURE
AUTHORIZATION TOTAL FEE RFPROVRLS --, — -
CONTRACT WITH THE HEREIN NAMED CON• ---_ - —
1 HAVE AT THIS DATE A —� (-----
TRACTOR TO CONNECT THE ABOVE DESCRl6€D EXISTING DWELLING `REW_HOUS_ESEWER
TO THE PUBLIC SEWER, 19---- CONNECT ADDITIONAL
DAY OF BUILDIN�K-
SIGNED THIS--
SEPTIC TANK,SEEP,PIT(5)
OWNER OR DRAINFIELD
OWNERS AGENT AND/OR' - -
ADDRESS -- DRRYWELL
THAT I HAVE READ THIS APPLICATION r SEWEA OR
1 HEREBY ACKNOWLEDGE STATE LAWS REGULATING ALTER,REPA.R,
ALL COUNTY ORDINANCES AND SEWA6E SYSTEM -----'I
AND STATE THAT TiE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPO
WITH 4D/OR pISCONNECT PLUG AND
PLUMBING AND SEWERS. PROPERLY REGISTERED A. ABANDON HOUSE SEINER
I HEREBY CERTIFY THAT i AM BACKFILL SEPTIC TANKS❑
BY I A ANGELES COUNTY AND STATE VE
REQUIRED AM THE LEGAL OWNER OF THE A CESSPOOLS❑ -
LICENSED AS SEEP. IT(S) ❑
CALIFORNIA OR THAT _
DESCRIBED RESIDENTIAL PROPERTY.
ROBERTA. WOOD
----
SIGNATURE ` 1> .'�_r
p¢PTURE VALIDATION SUPERVISiNC:MECHANICAL ENGINES
CASH
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