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HomeMy Public PortalAbout5826-5826 1/2 ROWLAND AVE_Sewer__ i 62 APPLICATION FOR P&MIT COUNTY OF LOS ANGELES r DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DI SPG SAL ' BUILDING AND SAFETY DIVISION BII_DIN tr-<' gOHN A. LAMBIE, County Engineer AP[DRESS WILLIAM A. IENSEN, Supt of Building , L OCALi7YJx:- _ N-AREST � FOR APPLICANT TO FILL IN ORDS ST. - LEGAL DEGCR PTi CN :OT NO1-' OWNER MAIL BLOCK TRACT ADDRESS N0 OF BL LIG S. izE f LOT x '��'J NON, _C_ LOT CITY TEL.. NO- USE OF SUILL d -; �� - DISTRICT NO. GROUPFLAP PRQCESSE:.D BY -- - 'L.__— SK. PG. yy d _ON7Rr,TOR ADDRESS �.� _.. �q_. � _ CONNECTION DATA 3CP H CITY__��p .'.'. •; tL NO. __— g.". _. - N j.. �..___ _ _.,.,_—__— ___ ____ STATE i-!'Eft MANHOLE REFERENCE -r L REG IS TRA. ON 1140 � _ ❑ COUNTY } ,� ><- y;'f ONE,ti NO. pE_ .Ri �ioN e� wIz�L FEE ------ -- t - -� _ TYPE OF CONNECTION LENGTH FROM . HOLS EWER CO NN ECTI NG TO Y. CURB P.L. M.L To P.L. SY3, PUSLIC..'StWFiQ $5.300 P.C, NO --_ _ JOB NO. I:.PY.C TANK aEEPAG PIT PR L r0.IMP.NO- P T5 AND/ORDRA; F E D f2� §tO.QO — -- — CL SOUSE SEWER.f'ChNNE TING TO I __r I TRUNK PER 'IT N9,,'5,.-,,, ROAD PERMIT NO.. f PRIVATE DISPOSAL SYSTEM $3.00 1 :OVERFLOWOUSE E PIBTI-LTR 4I)N FIELD - AFFiDAL kT wA'i — - AT - - - -_-- _- FU EY R EASEMENT f RECORD fNSTR NO DECONN E _1 _. J•LQRK 7O HOUSE SEWER @ $3 DO-- OVERFLOW 0 F X7N CE F OOL.DRYNELL MANHOLE @ $500 eyi r ALTER,RF.Pn�R OR kBA ND•�N HOUSE ----'� HWY.OR ST.WIDENING .fir SEW ER CC D R^,Sal YSTEM � ?53.00 ' STATE ENCROA,CHOAENT PERMIT NO. WA.5T'E APPROVAL 'V NVAtlJCP-S PERMIT...____._. -. 2 CHARGP.`� 00 AUTHORIZATION OFtNEC,ION HARGE FEE TOTAL F`EE � �., __ __-- 1 }LAVE A.T THIS DATE. A CONTRACT WITH THE HEREIN NAMED CCN. F2EIMBU RSE MENT_FEE 'I RACTOR ':-O CO'f E 'f THE ABOVE DESCRIBED EXISTING DW'E;.LLIN x p_._ 70 . THE I,USLiC SEW E.R.. APPROVALS ©ATE.. INSP EC T'OR S NATURE: SIGNED THIS---- AY flF _._?3„�„ — `- -- -- - OWNER IDR NEW HOUSE SEWER___ OWNERS AGENT___ CONNECT ADDITIONAL BUILDING OR WORK I ADDRL S SEPT!C TANK,SEEP,PIT{S} IY . 1 HEREBY ACKNOWLEDGE THAT • HAVE: W.AD THIS APPLICATION AND/OR DRAIN FIELD AND STATE. 'T+IAT THE. ABOVE iS. CORRECT AND AGREE TO COMPLY ______� _______—____ _ —__—_• ___._ --._..._._ N/1"'H ALL COUNTYORDINANCES AND STATE LAWS REGJLATi N-G PLUMBING AND SEW E_.RS, CESSPOOL. ORYWELL. f HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,$EWER OR i LiCENBED AS REQUIRED BY LOS ANG,LES' COUNTY AND STATE OF SEWAGE.DISPOSAL SYSTEM CALIFORNIA OR THAT i AM THE LEGAL OWNER Of, AND INTENDDISCONNECT PLUG AND I *— RES IDE IN. THEEIOI iR EIESCRIMED -R 5Yb ENTtAL PROPERTY. 1 /j �y ABAN CUN HOUSE 6E\Ncft SIGNATURE i <J,y OF PERMIYTL.f ,+y mpg BACKFILL 55PTiC TANKS LI i '' --. -- .SEEP,P T(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD GK. M.D. CASH SUPE'RVl_SIN�G MECHANICAL.. ENGINEER S� f -