HomeMy Public PortalAbout5946 ROWLAND AVE_Sewer__ e 4
E808 to-63 APPLICATIOi'�I F'CR PERMIT ,
DISPOSAL- �v
�6A642D SEWER
COUNTY' OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER '�ya3
6UILD.NG - �Fr- _.._
AOD,REN 44,
BUILDING AND SAFETY DIVISION __^--__--y
IpHN A. LAMBIE, County Engineer
_ � ----
WILLIAM A. IENSEN, Su9I Building
pt LOCALITY —
N ARE T _ =.
_
CROSS 5T.
FOR APPLICANT TO FILLIN _ -
-. _.._•� a -" OWNER T -
LFG4L.... ° r
.____-_ MAIL
l0T NO. �_ '-'-' _
DE SCRIF'TION _____- - - -r ADDR SS , .,X.%'�e — -_ x... _-
_E
TRACT ,,.., --
BLOC. - � -- TEL. IN
---_. CITY -
-. NO. OF BLOGS. --- PROCESSED BY
''yy NO .%N ON LOT MAP
SIZE OF LOT J _�-- -- DISTRICT NO- GROUP BK PG
USE OF ' -- - - -
SUILDINGS ._
CONNECTION DATA
CONTRACTOR -
y ��� DEPTH
ADDRESS
STATION
TEL
NO
STATE MANHOLE REFERENCE _.
— -_ COUNTY - -� r LENGTH}'ROM
REGISTR A710N NO. __ _- _ - TYPE OF coNt9ECT.lON M L 70{e L. _ _ -_._.,- >'
PEC --CURB P.L. _
No DESCRIPTION OF WORK - T---T- Y p.c.No.
- r -- - - _ 0
1 HOUSE SEWCR CONNECTING B5.00-+_ - JOB No. -____-- �y
-i- _..__--__._
_-' I _- CO IMP.NO --
PUBLIC SEWER ---- ------
5EP7;i=TANK.
SEEPAGE PIT Oft $10 00 .�_. ROAD PERMIT NO.
�� R DRA INFIELtl - TR;NK PERMIT NO. _
PIT.5 AND'OR - _ IN TP NO DATE
---.---- •.
--- T HousE SENYER i.ONNE:CTING TO rig 00 RECORD 'S
+ _ -. __. ___- EASEMENT ..-•-
PRIVA .:ISPO SA SYSTEM
_- ---- P.FFIDAVI7 I1 - — _-
__ 1 1.
_____
CCNNF CT ADDITION Al_BLDG.OR @ $3.00 I WAIVER�, - --^ c�
1
WORN TO HOUSE SEWER - '�----
-`- - -- W SEEPAGE PIT DRAINFIELD ___ - ---
9'✓CRFI D �HOLF� 00
-t_----- HWY. OR ST.WIDENING _-_---___ .�
E XTN CE'5FO L---YWEIL.MAN -- -Y- _.__-____-
-____-
-}- --- ---G�ABANDON HOUSE I
.,AL 5Y TEM �3 OO --r .-_ STATE ENCR ACHMLN _'.._---_---_
' SEWER PERMIT fJ0
— — --
INDUSTRIAL
WASTE APPROVAL
ARGES
R
®YY 1�G ,S PERMIT +-OO CONNECTION CHARGE FEE
YY 1`7 i.�S1 _
AUTHORIZATION TOTAL FE_ E RE MBURSEMENT FEE _---
tlATF INSPECTOR'S �GNATURE
APPROVALS - _
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED - —_ - -_- _-- -
7RACTCR TO CCN NEC'' THE ABOVE DESCRIBED EXISTING DSN FEEING ----_- - - -
TO THE PUBLIC SEWER
DAY --
_._--
NEWHOUSE SE'W ER
SIGNED THIS ,
---- CONNECT ADDITIONAL
OWNER OR
OWNERS A ENT- ----- BUILDING OR NK WEEP PIT(S)
- -
-- SEPTIC'ANK 5
- --.-- —
AND'OR DRAINFIEID _- 1
7 HEREBY
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION DRYWELL ❑ _
T THE A80VE IS CORRECT AND AGREE E COMPLY ,
AND STATE THAT CE55YOOL ❑ -r--_._--_-----
WITH ALL COUNTY ORDINANCFS AND
STATE LAWS REGULATING - _- -
SEWF_R5. ALTER.REPAIR,SEWER
pLU pq F31NG AND PROPERLY REGISTERED AND/OR SEWAGE GISPOSAL SYSTEM
ZTIFY ''HAT I AM qND STATE OF
_ --
1 HEREBY ti-E'.OIJIR BY L.05 AN L. COUNTY p15COfJNECT PLUG AND
Ll AS ,AL OWNER AND INTEND TO WFR --- --i
' M THE L RE5IDEN ROP TY. ABANDON HOUSE SE
CALIFORNIA OR A
RF_SIDE IN. TH V OESGRiB --
BACKFILL SEPTIC TANKS ❑
---- OLS
SEEP,PiT(S) ❑ CESSPO
SIGNATURE - - -' WOOD
OF PERMITT� — ROBB
ERT A.
VAIJDATIO;{Y-`--, SUPERVISING MECHANICAL ENGINEER
CK, M.O. 1- CASH,
7'u 6SAE-663 12.54 APPLICATION ORPERMIT
7
■
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D#.DMSA L , 1`
Department of County Engineer
County of Los Angeles BUILDING
WM.J, FOX, COUNTY ENGINEER ADDRES ,
CASSATT D.GRIFFIN,SUPT OF BUILDING LOCAL 'Y s
FOR APPLICANT TO TTL NEAREST
CROSS
._ ST. -
LEGAL
DESCRIPTION LOT N0, OWNER
BLOCK TRACT -ysMAI -
- -- ADDRESS
SIZE OF zd NO. 0�'BLDGS, -
NOW_ON L CITY TEL. N.O..
USE OF
B.UILDINGS._ WSIRICT NO. GROUP i MAP
EK PG
CONTRACTOR 1
ADDRESS ; ` CONNECTION DATA
Ci NO .. �- STATION :ate..^. .�'"E' _,.a,; PTN
j/y✓, �STATEMrt ,^'�REFERtNC£
REG-}yfiRAT10M NG- y.+I OUNTY— UPPER
`4 �',&E{ ')NNECTION LENGTH FROM
NO. !
DESCRIPTION OF WORK FEE Y Culla P,L. M,L. TO P.L.
HOUSE SEWER CONNECTING To
PUBLIC SEWER_ bpi% 3.50
HOUSE SEWER CONNECTING TO —
PRIVATE DISPOSAL SYSTEM t.00 -
�� CONNECT ADDITIONAL BLDG. OR {i CO. IMP. N0. JOB. NO.
_
WORK TO HOUSE SEWER 1.00 I_ _ _
ALTER OR REPAIR EXISTING
SFVER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. �— ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER 3TA,E EINCI?OACHIAENT I
AND/OR DISPOSAL SY57-M__ 1.00 I PERM;IT NO,
SEPTIC TANK;SEEPAGE PIT OR RIAL
PITS AND/OR DR1NDU5T
_AINFIELD 2.00 i,_,—__ _
�I CESSPOOL DRYW£LL WASTE RIA .RL
L
SPECIAL CONDITIONS ONLY 2.00 I� 1 CHARGES
:CNNECTION CHARGE FEE
OWNERS PERM T t 00
AUTHORIZATION xox �~ REIMBURSEMENT PEE
1 HAVE THIS DATE CONTRACTED FWITH THE: HF.$EIN NAMED CON..
TRACTOR TO CONNECT THE ABOV DES.CRIB `EXISTING D}h hLLING APPROVALS DAT 1• INSPECIOR'S SIGNATURE_
TO THE PUBLIC SEWS —
,i -
SIGNED THIS DIY Or --I' __--NEW HOUSE SEWER�_-- -t--
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT .< -� BUILD NG C_R WORK— _.—
�"� _ TIC TANK, SEEP,PIT(S)
ADDRESS '° ° - _AND/OR DRAINFIELD
I HEREBY A- NOWLEDXNAVES
TIiAT i HAVE READ THIS APPLICATION CESSPOOL C7 DRYWELL
AND STATE THAT THE AS CORRECT AND AGREE TO COMPLY .m--.-
WITH ALL COUNTY OR AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMPING AND SEWERS. SEWAGE DISPOSAL SYSTEM_
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED
-------� ��— - -
LICENSED-AS REQUIRED BY LOS Ap4i�ELES COUNTY AND STATE OF OI.SCONNECT PLUG AND
CALIFORNIA OR TH I A THE,,!L GAL OW ER OF THE ABOVE E_3ANDON HOUSE SEWER
DESCRIBED RE51D£ ERT
.� BACKFILL SEPTIC TANKS CI
£cP PIT(S) ❑ CESSPOOLS[IJ
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION
. BY BY
DEPUTY - DEPUTY
BY BY