HomeMy Public PortalAbout5831 ROWLAND AVE_Sewer__ DEPARRT)ViENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS - - -FOR APPLICANT TO FILL IN LOCALITY
BUILDING _1 j f� NEAREST
ADDRESS -- }� � z GROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST sKrr� —%y S
CROSS S7 �:fi �. ✓ R .« ---
RECEIVED BY Ready for Inspection DATE ISSUED
-OWNER ,
MAIL
ADDRESS } !-�� L /iLr/( �l yq y' USE ZONE OCCUPANCY BK MAP PG
CITY TELAO. f.
CONTRACTOR
CHARGES REIMBURSEMENT FEE
ADDRESS 792,2 NO. ENCINIg TA t pp ":y REQUIRED
CITY I�I) I• �11FlL.NO. R`R
NOT REQUIRED
� JOB.N0. CONNECTION CHARGE FEE
STATE
REGISTRATION NO. COUNTY- CO.IMP.NO.
LEGAL '-�' -- - _ RECEIPT k0. I DATE BY
DESCRIPTION LOT N0. i
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLOCS. r
_ r NOW ON LOT RECEIPT NO. ( DATE I BY
USE OF l
BUILDINGS
N0. DESCRIPTION OF WORK FEE TRUNK PERMIT NO.
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLIC SEWER $ 3.50
------- --
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 _ WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 _ CONNECTION DATA
DISCONNECT AND ABANDON SEWER 1
AND/OR DISPOSAL SYSTEM 1.08 STATION uf PTH
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL I I UPPER LOWER
SPECIAL CONDITIONS ONLY 2.00 TYPE.017 CONNECTION LENGTH FROM
I Y. CURB P. M.L.TO P.L.
OWNERS PERMIT _ $ I I oo ---- --
AUTHORIZATION TOTAL FEE -- -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS- r --:-DAY OF- ---- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT d-s ri ' k _ BUILDING OR WORK l
ADDRESS M ``L Ir. ^K fr �• SEPTIC TANK,SEEP.PIT($)
_ , I---------- AND/ORDRAINFIELD
- — _
CAT —
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL Ej
ION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES- COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT i AWTHE LEGAL OWN,
£R OF THE ABOVE DESCRIBED �! IDE /�L PROPERTY, BACKFILL SEPTIC TANKS
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE a f 4
OF PERMITTEE----
,6A6421)
ERMITTEE:_.,6A642D 663 12/52 ..