HomeMy Public PortalAbout5749 ROWLAND AVE_Sewer__ �E808 10-63
6A64201 APPLICATION FOR PERM.I t`' � t,
COUNTY OF LOS ANGELES SANER—SEWAGE DISPOSAL
7..d
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DI`lISION B !LD:NG ��� d
ADDRESS 25'
JOHN A. LAMBIE,
County Engineer — --- .-_ _._
WILLIAM A. IENSBN, Supt of Building
1 OCAL TY
Nf AREdT
FOR APPLICANT TO FILL IN 2055 ST.
-- --- _ - —
LIEGAL
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DESCRIPTION LOT 1 1 -- OWNER V __
�+ ,a^
MAIL
BLOCK THAT __./�- s�0.:: ADDRESS
NO, OP BLDGS_ -
S{AE OF LOT NOW ON LOT C1TY TEL. NO.
USE OF. y�-�,.o �� y �¢`
BVILOiN6s .!' l i✓ r� •'� 6 '•' �,}^ DISTRICT NO. GROUP MRf' FRO E5tiEC�IIT
PG
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CONTRACTOR. �s/,y fy'cADDRESS _0 '-
CONNECTION DATA
c,T}' °t `' a e��".t'�'/-_TEL NO. 1 "r .Xlc��Y STATION DEPTH
ny..9STAT:E
UPPER
GI, ATIOhi N�} ,/J+��y MANHOLE REFERENCE. -LOWER
+" • ___._.__._ COUNTY LOYtFR
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTIONLENGTH FROM
HOUSE SEWER CCNh ECTING TO ''� Y. '?;R$ P.L. M.L.TOPAL.
PUBLIC SEWER'. @ $'3.00
O _—_�
—_ R -.— P.C.NO.
5 �.IC TANK ,.�E PAGE P!T'
PITS ANO,'OR DRAINFIELD 310.00 CO. !Mie.NO. JOB NC,
H HOUSE SEWER CONNECTING TO----- --_-_� _-_— TRUNK PERMIT NO. � ROAD PERMIT NO,
PRIVATE DISPOSAL.SYSTEM @ $3.00
C JNFC; ADDITIONAL AFFIDAVIT ' WAiVl,9E•IS R � EASEMCNY RECORD.ihFSTR-NO DAT't ;
j�IfP WORK TO HOUSE SEWER $3.00 •„y ��.•� � � d
OVCR.F"..OW SEEPAGE PIT,DRAINFIELD
EXTN.<q L,DRYWELL.MANHOLE @ $5.00
HWY,OR ST.WIDENING LT
F R PP R OR ABANDON HOU--E
SEWIR OR DISP05AL SYSTEM @ $3 00
STATE EN ROA LAMENT
- C
PERMIT NO
INDUST t 4 )'�,'
� Lt
WASTE APPROVAL '�' f^-- _ 2-d4_.---_�-+_--
y
__ __. CHARGES 7
OWIVER'� PERMIT 2' 00 ----- —._, ------- --- -----
Y -_ CONNECTION CHAR{ FEE
AUTHORIZATION TOTAL FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RE1MB 'P.SEMENT FEE
TRACTOR '0 CONNECT THE ABOVE DESCRiBED EXISTING DWELLING ----' -------'—
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF tg.^. —_...----- -----' - -_._---
OWNER OR NEW HOUSE SEWER (
OWNERS AGENT—.—___.____--____---- CONNECT ADDITIONAL
BUI.I-DING OR WORK -
ADDRESS_ _ _ - - _---__ ----4---i ._ —_ _.__. _ 1-j---i-------
__
I H .. - ___ -__ __ __ -.__ ..___._.. SEPTIC TANK.SEEP,PIT(S)
I }i RE$Y Ac'Kh.CWI,EDGE 7FiAT 1 HAVE READ THIS APPLICATION AND,OR GRAINFIELD
AND STATE THAT THE ABOVE IS, CORRECT AND AGREE TO COMPLY ----- ----------}— -
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING I.
PLUMBING AND SEWERS. CESSPOOL DRYWELL
HEREBY CERTIFY THAT I AM PROPERLY REGI STEREO ANDi OR ALTER,REPAIR,SEWER OR
1.CEN5ED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL;FOP.N IA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO pISCONNECT PLUG AND
RESIDE IN, THE ABOVESCRI$ED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE, BACKFILL SEPTIC T'AhiKS P1
SEEP.PIT(S) 0 CESSPOOLS. ❑..
VALIDATION,—_�_ ROBERT A. WOOD
SUPERVISING MECHANICAL. ENGINEER
CK. M.O. ''CASH,
l.t a€3'6 1 1 0 DEC 2 1 0 D 5.00—
t.,
E8G8 5-65
6A6420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Illill.ING v(MIX
JOHN A. EAMBIV CountyF"ngjn,.Vr ADDRESS
COLEMAN W. Supt. of Building
LOCALITY
NEAREST 71
FOR APPLICANT TO FILL IN CROSS ST.
DESCRIPTION LOT NO 6-d OWNER a
MAIL
BLOCK TRACT ..-R...
NO. OF ULDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS SK PG
A
CONTIR CT R
0
ADDRESS CONNECTION DATA
-ox
STATION
-__--.e`
CITY'
DEPTH
IT� NO.
LICENSE LICENSE UPPER
N 0 CLASS MANHOLE REFERENCE
NO. D RIPTION OF WORK FEE TYPE DF,-(;O(4NFCTION LENGTH FR�
EW RB - P.L.Y
ER-CON-N—EC T HN-C T 5—_—_ CU M.L.TO P.L.
PUBLIC SEWER P.C.NO,
NO. JOB NO,
PITS AND OR DRAINF!ELD 510. -C—._IMP0
HOUSE SEWER. CONNECTING TO I TRUNK PERMIT NO. ROAD PERMIT NO. u
E DISPOSAL SYSTEM 00i
PRiVAT $ 3,
'CONNECT ADDI TIONAL-SL5G. OR wmi_ E
g EA�EIjE.T w
AFFIDAVIT E RECORD.IN r
WORK TO HOUSE SEWER $ 3�001 0
US
SEWER OR DISPOSAL SYSTEM $ 3.00 UA
r7ETfrL DAF I=T'AE--PTS_fTR'47TT7Fl I HWY, OR ST.WIDENING
EX T N. CESSPOOL, MANHOLE $ 5.00 ' � MCIA�CH
-- SAENROENCROACHMENT
Z
PERCOLATION TEST 5 $ 5.00
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS
AUTHORIZATIONCONNECTION CHARGE FEE
I HAV AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEh�NTFEF ly;
TRACTOR TO CON NFCT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBL;C SEWER. APPROV14� �-ATE INSPECTOR'S SIGNATURE
SIGNED THIS—DAY OF —19-- -- ---
OWNER OR
OWNEROR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR ORAINFIELD
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY
ORDINANCES AND STATE LAWS REGULATING
PLU MB iNG, AND SEWERS. CESSPOOL El DRYWELL El
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA
A OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVEIDESCRISED RESIDENTIAL PROPERTY.
ABANDON HOUSE SEWER
SIG TURE
OA
FPERMITTEE
N BACKFILL SEPTIC TAN
SEEP,PIT(S
I [I CES.POLgA�
VALIDATI0
CK. M.O. �CASH
L 8 5 W'So NOV 16 1 0 0 7.00-