HomeMy Public PortalAbout5759 ROWLAND AVE_Sewer__ e E-ce3 3=5fi APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX. COUNTY ENGINEER
CASSATT D.GRIFFIN,SUP'T OP BUILDING LOCALITY .�-•G. ?, ,., ;�^"
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FOR APPLICANT TO FILL IN weAREsr � � . i. L
LEGAL
DESCRIPTION_ LOT_N_O,_ � OWNER 1
BLOCK s TRACT ?+i—/ MAIL
ADDRESS ar..
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SIZE OF LOT N0.OF BLDGS,NOW ON LOTCITY TEL.
USE OF '� _
BUILDINGS_ - Aa.t-l.-- DISTRICT NO, GROUP MAP
BK PG
CONTRACTOR
ADDRESS '� CONNECTION DATA
CITY '
STATION0.� _ a' � , yTTEL NgE.P.TH
MAN14OLEREFERENCc
REGISTRA NyO. ; r
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COUNTY
LO`L.R
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N0. 1 DESCRIPTION OF IVORK FEE —'-
TYPE jr Lw,'IECTIONLENGTH FROM
f 6USE SEWER CONNECTING TO Y. CURB P.L. M 1„,_TO P.
J
P 'LIC 3 WER !r5- $ 3.50
.-. - ---
HOUSE SEWER CONNECTING TO
1
PRIVATE D SPOSAL SYSTEM _-
-- . 1
CQNNEOT ADDITIONAL BLDG.OR �-- - P C .NO, {
WORK TO HOUSE SEWER .�. 1.00 { _ CO...,INIP, NO. OB� NO___--
ALTER OR REPAIR EXISTING. _— -- - _- v -._
SM1LSEER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO ROAD PERMIT NO.
!f DISCONNECT AND ABANDON SEWER .— .V~ .STATE ENCROACH�t9E:NT..._-.�^^�----y-- - -
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AND/02 DISI SF,L SYSTEM, 1.00 _ PERMIT NO.
SEPTIC TAWY SEEPAGE PIT ORI [ ---- - ---------- --. _-,r
P t5
AND/OR DRAINFIELD ,00_E� l INDUSTRIAL
CESSPOOL DRYWELL WASTEAPPROVAL
SPECIAL CONDITIONS ONLY 2.001
CHARGES
- - --f-- -
CONNECTION CHARGE FEE --_--i ---`^'�
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT FHEi ROVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPGCTORSSIGPJATURE
TO THE PUBLIC SEWER --- --- — -- —�_._
„,,,.. NEW HOUSE SEWER
SIGNED THIS AY F 9
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OWNER uR CONNECT ADDITIONAL
OWNERS AGENT =d' iI I1' - • _BUILDING OR WORK _
SEPTIC TANK, SEEP, PIT(S) -
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AND/OR DRAI_NFIFL.D �-
I HEREBY ACKNOWLEDGE THAT I HAVE READ- HIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,.REPAIR, SEWER OR
PLUMBING AND SEWERS. . SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/CR --” -- -"-----_"--` -�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND I
CALIFORNIA R THAT I AM THE LEGAL OWNEII OF T-E ABOVE _ ABANDON HOUSE SEWER
SCRIBED R ENT °PROPER i^ ,
BACKFILL SEPTIC)._ TANKS❑ I .--e..._.
SEEP.PITJT(S) ❑ CESSPOOLS
F PERMITTi E � 'V
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLSG. INSPECTOR