HomeMy Public PortalAbout5715 ROWLAND AVE_Sewer__ Y
6E808 1
A642D 63 APPLICATION FOR PERMIT _
4
COUNTY OF LOS ANGELES ,EWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 13,UILDING ,
JOHN A. LAMBIE, County EngineerWILLIAMA.A. JENSEN, Sup't of Building LOCALITY
13-1
NEAREST'
FOR APPLICANT TO FILL IN CROSST
- - - - - - -
T�E AI_
DESCRrP ION LOT NO �,. OWNER ,L(, /
M 41L �r
BLOCK TRACT ' ADDRESS A'�d (��
NO. OP BLDGS.
SIZE OF LOT NOW CN LOT CITY L A.`t d"5 �;. T`' EL. NO.
U5£ OF DISTRICT NO. GROUP MAP PROCESSED BY
:BUtLDiNGS'
BK PG
CONTRACTOR _ fe3,' v E�➢..�,_ ti, - ',..
ADDRESS _ '- t�� x CONNECTION DATA -
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_
STATION' DEPTH
EL
� T �--r
STATI: MANIiCSE REFERENCE - --- -
NQ•.75TRAG ESCR PTION SOF W� y COUNTY _ LUi'FEROVTIE R.._.
Y
r K }EE TYPE OF CONNECTION LENGTH.FROM
}.O
USE SEWER CONN EE77NG 70 Y. CURB P L. M.L. "!O i'.!_.
PUBLC'SEWER $5.00 -.-_ ..-__ ____-__
-_ _. _ ,r.-__ -_-_ P C No. 0
SGPT IC AND/OR
SEEPAGE PIT OR - `b3
� co,!MP NO. JB NO - -
PITS AND/QR DRAINFIEL6 � $.0.00 �.
HOUSE SEWER CONNECTING TO � TRUNK PERMIT NO. ROAD PERMIT NO.
rRIVATE DISPOSAL SYSTEM @ $3.00
f CONNECT ADDITIONAL BLDG OR -+ ) AFFIDAVIT WA4Y£R [ASPM ExF I R�C:O RC INSTR h0 DATE 0
WORK TO HOUSE SEWER $3.00 _
_- __. ..- -1
__. -
rOVERFLOW SEEPAGE P17DRAIN FIELD �. j"•� 7��-,_,_.�.� _ „t_=. _ -_., -L. _-__... .__
EXT I'CESCPOOL.,ORYWELL..MANN OLE @ $5:00 - J
-.-. HWY.OR ST WIDEN)NiG' /
! ALTER REPAIR OR ABANDON HOUSE ! -_-__- - .
SEWER OR DISPOSAL SYSTEM STATE ENCROACHMENT "-
j PERMIT NO,
-,_-
.__.-____--_-_
INDUSTRIAL
WASTE APPROVAL
OWNER'S PERMIT -' 2; oo ----
_-.__-_.__ CC'NNECTION CHARGE FEE -
AUTHORIZATION TOTAL FEE ___ -- ----------_-_---_-------_-_--__..__.-_-
'I HAVE AT THIS DATE A CONTRACT Wf TH !'HE HEREIN NAMED CON- REi_MBU RSFMENT FEE:
TRACTOR (TO CNNECT THE. ABOVE Dr SCRIBED EXISTING DWELLING
TO THE PUBII SEWER. APPROVALS DATE IN6P ECTOWS IGNATURE
SIGNED THIS---DAY OF. ---------I9'-- "- ----- i ---- ...--
OWNER OR NEW HOUSE SEWER I
OWNERS AGENT._ -_.-_-_
-' --- CONNECT ADDITIONAL I i
BUILDING OR WORK -
__ 5EPTIC TANK,SEEP,PIT($) -ty�
I HEREBY ALKNOWLEOGE THAT I HOVE.READ THIS APPLICATION AND/OR DRAINFIELD
AN STATE THAT 'THE ABOVE. 1S COR RirCT AND AGREE TO COMPLY ----------- -.-------�--� --. I ---------------
W17H'ALL COUNTY ORDINANCi_5 A•ND;'STATE LAWS REGULATING i� I
�` CESSPOOL DRYWELL
YLJ ME3I NO AND SEWERS j -
I HEREBY C_c'R 1=Y THAT t7,AJ.11 PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR !
LIC.ENS ED AS REQUIRED B�€. `S- ANG'LES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM j
AL; ORNIA OR THAT i A14"`+' F. L£G/lL OWNER OF, AND INTEND TO � __
❑ISCON NEi 'P PLUG AND
E !AL PROPERTY.
i
F
ES N, 71iE Ar:OV', OtS,{p@°R t8 D' R AGANDON HOUSE EWF,R
SIGNATURE ! ' --- --- L� --� -j !---- '----
OF E'ER M!TTEE 4 a - A..FILL SEPTIC TANKS
---- -- --" '; ._ --- SEEP.Pr, ,S? ❑ CESSPOOLS r I
VALIDATION ROBERT A. WOOD
SUPE RV[SI FIG MECHANICAL ENGINEER
-` CK. M.O. CASH -
16648 TO 82 15A642D !APPLICA dON FOR 4ERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building _
LOCALITY )
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
_ rA
,CRIP7ION LOT NO /" - OWNER
yyy'''F MA I'I_
BL��CK TRACT ,- - AbD RESS
NO. Or BLDGS.
SIVE OF L,CST NOW ON L07 CITY/��i ,� �'�-•,�'�°.'TEL. NO.
LIGE OF
BJ!LDfNG.S DISTRICT NO. GROUP I MAP PROCESSED BY
BK PG
CONTRACTOR
ADDFRFS - _ CONNECTION DA_ +' 2'
1�._� s .,✓ '
STATION ^y/, ff DEPTH
C17Y "' '- F_d•` r1 EL r1N0 ,�
S I ATE
R_C--i.STFAYIO_ NO ._ MANHOLE REFERENCE
f LOWER
4-
N
Rd _
NO- .
_
DESCRIPTION OF WORK FE - TI L OF Kt�FF,T ON LENGTH FROM �,..•
- -- - 1 -y --
HOUSE SEWER LONNE-C NCs YO - ��I Y CURB j� P.L.. M,L TO P.L..
PUBLIC SEWER @ $5 00 _..- __ ��___-_-.._ __ _-,_- 0
SJOB No.
r
IC TANK SEE PALE P!Y OR
ITS AND/OR ORAINP'IELD C $90000 -.__ - ._- _ -_.- _.___ -_ _ p�
-.- CO SMP NO
OUSE.SEWER CONNECTVNG TO TRUNK PERMIT NO ROAD PERMIT NOZ _4) � LJ
-__-!
PRIVATE O 5POSAL 5YS7EM _ @ S3OG
C O4NEC.T ADDITIONAL BLDG.OR C AFP147A V.T l wAjvR.I CASEMENT RECORD,INST No.� DF�.TE
..
Sh ORK TO HOU5F ST'WER 53,00 -
�OVf..Rt-OW SEEPAUEPIT DR.AI`3FIEL.D
_.
EXT N CESSPOOL.,DRYW.L L„MANHOLE: $5.00 i NNWY...v^^RST.WIDENING z
I-AL7ER;REP.4lR OR mgADON HOUSE. -
____ _-.._._
SEWER OR DISPOSAL SYSTEM $3.00- _-__4_-___-, S7A7E.EN aROAEH MEPIT
i PERME7 Nq.
_ -
_ INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEXS PERM-IT � 2'ao -- _ _ ___.i_-__ -_ ---,-_ -----.-.-------_.____-
- --
-J _CONNEC 7'ON C!?ARG:E FEE
AUTHORIZATION TOTAL FEE �/ — - — —. ---------'- ---- ---- --
- fRSEMENT FE
I HAVE THIS H fS' DATE A CONTRACT WITH'TRACITH THE HEREIN NAMED CON R-_
ED - Y._ __.._.-_E
__-
TRACTORTO CO;'4 NECT' THE ABOVE DESCRIBED E.XIS'TiNG DWE LING ----- - yy p-----y------ I--------- - -- ----- -
TO THE PUBLIC SEWER. APPROVALS � DATE f Hq SPECTCR'S SIGNATURE
SIGNED THIS GAY
OWNER OR NEW HOU L SEWER
OWNERS AGENT_..__-__. —_-_—
CONNECTADDITIONAL
ADDRESS,
I
BUILDIN43 OR WORE I i
_ ,._
SEPTICTANK 5e. P PIT(S)
1 HEREBY ACKNOWLEDGE A+LEDGE Th1AT I HAVE READ THIS APPLICATION AND/0 R DkAIf CF'16LD
AND
STATE THA ,HE ABOVE 15 CORRECT F ND A:. £ TO COMPLY
%TATE LAWS REGULATING
WEY'�.. ALA.AND
NT” URUI1`a N.Nt'Es 9.NL: CESSPOOL LI ORYWELL r]
PLUM Bf?tiG ANO EW E.SS.
I 7EREE3Y C::.'RTIFv THAT I AM PROPERLY REWSTEP,E-.D AND/OR ALTER,REPAIR,SEWER OR i
LICENSED .AS REOLIiRED t_O5 ANGLES CO iNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA.OR TtiAT i AM T{iE LEgA1__OWNE.R OF AND INTEND TO DISCNECT ONPLUG ANO. ----_----�_-_---____-_----
RESIDE IN, THE ASO-gE 15ESCRIT: RESIDENTIAL,PROPERTY.
ABANDON HOUSE SEWER
$IGNATURE d r T Y._ % - � -` ,tL{_SEPTIC TANKS
OF PERM? XEE t _ .•. =e Tis) CESSP