HomeMy Public PortalAbout5920 ROWLAND AVE_Sewer__ 18A -
E66 Sf-S9 APPLICATION FOR PERMIT 1
>&E.863
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDINGaDDRESs
JOHN A. LA"vtBiE, COUNTY ENGINEER --�----
:.i''�'r• .r
'J CASSATT D. GRIFFIN, SUPT OF BUiLDiNG LOCALITYNEAREST
FOR APPLICANT TO FILL IN CROSS ST.
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DESC
- R! N0. r zr ' --OWNER - ;3J
- -PT!ON LOT- � _ --
MAIL
BLOCK TRACT .k ./�
F. r d
1'NO.OF BLDGS,
_SIZE O:F LOT r `A� ys NOW ON LO7 CITY TEL. NO. y:,BU
USELDF7NGS j�r;. . .+ i -------- DISTRICT NO. - GROUP I MAp..
CONTRACTOR ss ^ f
— r CONNECTION DATA
ADDRESS --
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P 1 STATION Lv 3 DEPTH
CITY 'i#{� TEL N0. , � �' - ,y _�UPPE
��k� MANHOLE REFERENCE
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REGISTRATION NO. ,*,! �„� COUNTY - -�
10. DESCRIPTION OF'ffOA FEE - — ------- -
- �- TYPE OTfON LENGTH FROM J
-� HOUSE SEWER CONNECTING TO -_- y CURS "' RL. M_L.TO P.L.
PUBLICSEWER _ @ $3.50 -----
SEPTIC TANK.,SEEPAGE PIT OR -
_PITSAND/ORDRAINFIELD _ Vii. $E.001__,_ ------
-_- OVERFLOW SEEPAGE PIT,DRAINFIELD --- ,,.- P C. N9.._.-----i
I EXTN.,CESSPOOL,DRYWELL,MANHOLE
?! $2.00 f CO, IMP. N0. .�y � JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM _ la $100 I _ TRUNK PERMIT NO. - _-ROAD PERMIT N0.
----- ----- --- -
1 CONNECTADDITIONALBLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Gv $1.00 - PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (c4 $.f.GO __-. WASTE APPROVAL
CHARGES
.. �--.-- --- .-- -. --,__-- CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00
$� REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE APPROVALS
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - - - --- -- -� - - -- - -
7O THE PUBLIC SEWER. - NEW HOUSE SEWER
-
SIGNED THIS. —DAY OF <`r�� X19_-- CONNECT ADDITIONAL i
OWNER OR -;P BUILDING OR WORK - -
OWNERS AGENT SEPTIC TANK,SEEP.PIT`(8)-- -' ----- -..-.�----�-----'------
AbDRE3,a..,k.`_r ? S - AND/OR DRAINFIELD
1 HEREBY A�KNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ➢RYWELLL]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR `I'
PLUMB114G AND SEWERS. _SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR llfiSC �(++1JECT PLUG AND—
4 ENSED AS +E0U RED BY 06 ANGELES.,COUNTY A,Ny;STA7E OF AB p( HOUSE SEWER
CA }FORNIA Q.}2 T T. 7 E LEGA 'OWNER F THE A �Y�E — - --
D.E D kcfSIDEN g.'. .� ..}_ y B, C.F'iLL SEPTIC TANKS t]
3i N TPI7(S) ❑ C SoPOOLS ] --- �_--
OF PERMITTEE -- - --
IOHN A. LAMBIE. COUNTY ENGINEER VALIDATIO *,,ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CK. U.Q. CASH