HomeMy Public PortalAbout5817 ROWLAND AVE_Sewer__ aaE-6�(i3;x.85.
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 ryN
JOHN A. !_A.MBIE, COUNTY ENGINEER ADDRESS — o_, c
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CASSATT D. GRIFFIN, SUPT OF BUILMNG LOCALITY �� .
NEAREST ----- _-�-
FOR APPLICANT TO FILL IN CROSS Sr_�� ��r ��..
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LEGAL
DESCRIPTION LOT NO �00" *e`" _QWNER —.—�-_ -.-- ---�- '- ---
---- —--- _ '-- MAIL r
BLOCK.---- TRACT . ,-,r� - -- ADDRESS
y 1
NO.OF BLDGS. CITY E
512E OF LOT NOW ON LOT TEL. NO..,4r ZZ,'
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USE:OF
DISTRICT NO. i GROUP MAP
BUILDINGS - — >� I f l-
.� BK PG -J�+
CONTRACTOR � ' �" _
CONNECTION DATA
ADDRESSg---g-----------------
-- .�.. STATION � � } .4 C7EP7fi �—` --
CITY TEL. NO. d "- "-- -- —'�—'
A-10/ MANHOLE r`".�t a"J� s� — UPPt.R
( "' PATE MANHO1wE REFF.RENGE-- y— —^ :f—
REGISTRATION
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REGISTRATION NOU ,g �' i' [� COUNTY
No. i —DESCRIPTION Of WORK FEE ---- — --
- - —'-- - TYPE OF CONNECTION LENGTH FROM may*
HOUSE SEWER CONNECTING TO .` _—
C. !
CURB P,L. M.L. TO P.L.
-. PUBLIC SEWER _ @ $3.50
SEPTI.,
?ITS ANWOR DRAINFIc
c (a $3.00 -�----
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO.
--� EXTN.,CESSPOO_L,PRYWELL,74ANHOLE r_$.2...00 i CO.1MP. N0 ,,, ' 106 NO.
HOUSE SEWER CONNECTING TO y �
PRIVATE DISPOSAL SYSTEM L $1.00 TRUNK PERMIT NO ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HQU$E SLV'ER �{�_$1.00 I_— ! PERMIT NO.
LTLR, OR REPAIR R ABANDON HOUSE i --_---- ---- _--
SEWER OR DISPOSAL SYSTEM ", $1.00 INDUSTRIAL
IAL
'- __----- _---_ .----- ._ _ WASTE APPROVAL
CHARGES
I
CONNECTION CHARGE FEE
OWNER'S PERMIT $ _ 1 Oo ---- ---- --- —w- -
-
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE-� Y
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA .Ell CON- ____-APPROVALS
llA7E' �INSA"TTOR'5S.GNATUr',.=_
.TRACTOR TO CONNECT 'THE ABOVE DESCRIBED EXISTING DWELLING j
TO THE PUBLIC SEWER. NEW HOUSE SEWER i
SIGNED THIS _,._.DAY OI 19_ CONNECT ADDITIONAL
OWNER OR _ BUILDING OR WORK
OWNERS AGENT
-- --'-----`--- -'--`--- r'--- -------`
SEPTIC TANK,SEEP,PIT(S) i
ADDRESS,. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS 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 j !
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/Oa — I
LICENSED As REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE. ABOVE _ABANDON.HOUSE
SEVdEk2_ I-V
DESERIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑SIGNATURE — —
*+ SEEP,PFT(S? L CESSPOOLS El
OF PERMITTEE •*��
i
I
IOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD,'CHIEF PLBG. INSPECTOR
CASH