HomeMy Public PortalAbout5816 ROWLAND AVE_Sewer__ ';808-8 APPLICATION FOR PERMIT I
:FDOS-S-$8
COUNTY OF LOS ANGELES SEWER—S E WAE "d I SOSA L
,DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LDING d ri
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN,Supt of Building .LOCALITY
7 NEAREST •�`' _ '
FOR AP PC TO IN CROSS ST. L- y-" -�5 -
LEGAL " ,..,.._.-- -
DESCRIPTION LOT N0. OWNED
� J
BLOCK. TRACT ,rte MAIL
N6OF BLDGS.rr ADDRESS -
SIZE OF LOT NOW ON LOT CITY TEL, N0.
USE OF '
BUILDINGS �" r='. DISTRICT ND. CROUP, MAP t PROCESSED BY
BK PG
CONTRaCTaR,.-_._ --, X--411L
ADDRESS ^� / I�,` s,d'(,� oma,%.._. CONNECTION
CITY TEL.N0. f t E; STATION DEPTH
'
STArE MANHOLE REFER NCE y
s, a �'�+- '' .A _ ❑ UPPER,
REGISTRATION N0. / - i y [i E0i3 iF� `
NO. DESCRIPTIO OP' WORK FEE~
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3.00 '� TYPE OF , TION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR Y. URB P.L. M.L.TO P.L.
PITS.AND/OR DRAINFIELD @ $3.00
OVER-LOW SF,EPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE (9 $2.00
HOUSE SEWER CONNECTING TO P.C,N0:
PRIVATE DISPOS_At SYSTEM P.. $IAO EO,IMA.NO. j/ �JOB NO. _
CONNECT ADDITIONAL BLDG.OR —TRUNKPERMIT N0. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 7T
ALTER, REPAIR OR ABANDONHOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 _PERMIT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DAT
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXt Y�iNG DWELLING EE INSPECTOR'S SIGNATURE_
TO THE PUBLIC SEWER. �'--
SIGNED THI DA-OF NEW HOUSE SEWER i
OWNER OR /� CONNECT ADDITIONAL
OWNERS AGENT ° - � � BUILDING OR WORK
ADDRESS___2 '1LL "- y Y SEPTIC TANK.,SEEP,PIT(S)
_ > ~.� AND/OR
_ DRAINFIELD
I HEREBY ACKNOWLEDGE'THAT I HAVE READ THIS APPLICATION v AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL(]
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGEDISPOSALSYSTEM
I HEREBY CERTIFY THAT I AM PRQFERLY REGIST" D AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRF
ABANDON HOUSE SEWERCAIiFORNiA OR E
DESCRIBED RESIDEN7t P OFERT BACKFILL SEPTIC TANKS I7
SEEP.PIT(S) �] CESSPOOLS
SIGNATURE ` „ %nw , _.OF PERMITTEE + —
�« VALIDATION ROBERT A.WOOD
J CK. N.o. CASH SUPERVISING MECHANICAL..ENGINEER
X4.