HomeMy Public PortalAbout6000 ROWLAND AVE_Sewer__ EDEPARTAU NT OF COUNTY ENGlNEE$ SEWER=SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY ` PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS/,_
F JPPLICA T TO FILL IN LDCALIT %
BUILDING �"v NEARES11 14
ADDRESS O_ OW ' ' CROSS ST. ap J me
LOCALITY /' DISTRICT NO. S IAL NO. PERMITNO. c
$
NEAREST J A ' g�S�j'
CROSS ST.
ECEIVED BY Ready for Inspection DATE ISSUED
OWNER l/J �_6ej�l ley-
MAIL '
e
ADDRESS UQ Q, 'I USEZONE OCCUPANCY BK MAP PG
ydo-
CITY _ ,,/�' TELAO. , �(JQ��! v1 1—=:-1 Z)�
CONTRACTOR Y ®p � •{ CO.IMP.NO.
ADDRESS
JOB N0. �--A
CITY TELAO. TRUNK PERMIT NO.`
STATE
REGISTRATION N0. ® .COUNTY ROAD PERMIT vv`
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK=- ' TRACT l B - INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT,, 146 NO.OF NOW ON LOTS CHARGES
USE OF
BUILDINGS ,./ CONNEC CHARGE FEE
1!0. DESCRIPTION OF WORK FEE
REIMBURSEMENT
/ HOUSE SEWER CONNECTING T0.
PUBLICSEWER a $ 5.50 S G- RECEIPT-NO. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
r� CONNECT ADDITIONAL BLOO.08 EXCEPTION RECORDS
�r WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 1 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PIT8 AND/OR DRAINFIELD 2.00 STATION a DEPTH 1
CESSPOOL—DRYW ELL �1
SPECIAL CONDITIONS ONLY 2.00 I MA EFERENCE
_ TYPE OF ECTION LENGTH FROM _
OWNERS PERMIT ; -p OO CURB .els M.L.TO P.L.
AUTHORIZATION TOTAL FEE
IHAVE 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___._._/.____.DAY OF.__ fR d6 _____.—_.__191Y. NEW HOUSE SEWER
OWNER OR ' CONNECT ADDITIONAL
OWNERS AGENT....._ .__ BUILDING OR WORK
/ ,� ,/ SEPTIC TANK,SEEP.PIT(S)
AODRESS_t:+��.Jllls.. O� A!4�..__ r �L.__..._._........_. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-• CESSPOOL[] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
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 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE • /' SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE. L � !, �vl�.v___..______..
7GA642A 663 7/55 vn- �
R
a E-663 tI�55 _APPLICATION FOR PERMIT 1
i& •E&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING {
JOHN A. LAMBIE, COUNTY ENGINEER _`'DURESS � •�. _ l��L���-
CASSATT D.GRIFFIN, SUPT OF BUILDING ' r �
LOCALITY
FOR. APPLICANT TO FILL IN CROSS sir. � �
- `LEGAL --- - -
DESCRIPTION LOT-NO
BLOCK TRACTMAIL
Dy
; X - _ ADRESS . L,''`
/�� N0. OF BLDGS.— � - e7
SIZE OF LOT •,
CITY f;f.+ < TEL NO.
NOW ON LOT _
BUIELDINGS DISTRICT . _ GROUP . M. P
CONTRACTOR - I ' UK PG
-
`
ADDRESS ---
CONNECTION DATA
g ---_—._----CONNECTION
DEPTH
CITY TEL. N0. --- -- -- --
--- -- _—_---
— MANHOLE REFERENCE
y, L STATE - LIDWE:R
REGISTRATION NO.. ❑ COUNTY ... .___.
No. DSCRiPTiOPd OF WOftki FEE -- = -- _ r
HOUSE SF.NER CONNECTING'TO j-'--"- TYPE OF CONNECTION LENGTH FROM
Y. _.- CURB P.L. M.L.TOP L.
PUBLICSEV4ER _ @ $3•50 --
SEPTIC TANK,SEEPAGE PIT OR
TS AND/ DRA_NFIELD
OVERFLOW SEEPAGE PIT,DRAINFIELU 40. TMP. NO. JOB N O
EXTN.,CESSPOOL,DRYWELL,PRANHOLE $2.00 .--_--_- - -__ --- -_..
_.I HOUSESEWER CONNECTINO j- -_ -
PRIVATE DISPOSAL SYSTEM {ru $1.00 TRUNK PERMIT NO, - ROdD PERMIT N0,
I G TI
___ -_-- -__
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (ri $ ..0 --; PERMIT NO.
ER,REPAIR OR dB HOUSE
SE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM
TF,M �u, $t._00 I - WASTE APPROVAL
_._ CifARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT1 oo -- - -——_ — `--- --- - -
-- � _ —
_.._.------. REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
f
I HAVE AT THIS DATE A CONTRACT WITHWITHTHE HF--REIN NAMED CON•
---APPROVALS DATE INSPECTO SSIGNA URE
T?ACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE 'UBL1C SEWER, NEW HOUSESESEWER
ER I
SIGNED T . DAY r 1D-_--.--- CONNECT ADDITIONAL
OWNER OR �- '� 1 BUILDING OR WORK - -- _.-
OWNERS AG.E
d✓� - --- --- - - _ -
^ SEPTIC TANK,SEEP.PiT(y)
ADDRESS.-- AND/OR DRAINFIEL6
T HEREBY ACKNOWLE GE THAT HAVE READ THIS APPLICATION -
.AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESS POOL D t.1 DRYWEI.L[] `
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR I.
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
---- -
I HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS THE LE LES COUNTY AND STATE OF ABANDON HOUSE SEWER !
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ----- - ------- -- -----------_._.-
DESCRIBED RE D N71AL PROPERTY. BACKFILL SEPTIC TANKS Fj
SIGNATURE .. SEEP.PIT(S) ❑ CESSPOOLS U
OF PERMITTE
i
IOHN A. LAMBIE. CouY ENGINEER VALIDATION ROBERT A. WOOD,CHIEF PLBG. IT,lspECTOR
CK M. DlA;zF'`
_y fes- f/',_1 3 (+ £s