HomeMy Public PortalAbout6001 ROWLAND AVE_Sewer__ v
766642D to-s
l6A.fi4APPLICATION FOR PERMIT"
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL "
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING =;
JOHN A. LAMBIE. County Engineer
WILLIAM A. JENSEN. Supt of Building
NEA RE: 7
FOR APPLICANT TO FILL IN LROSS ST LEGAL
DESCRIp"T'ION _7T Nf s OWNER
MAIL
BLOCK TRACTf 3 ADDRESS ✓ i
NO OF BLDGS.
SIZE O' LOT � 1 .1 NOW ON LO: i,..•• ..>i` ,TEL. Pd O.
USE OF
BUILDINGS —'" - ,�. ' DISTRICT NO. GROUP %IA.PF°ROCE:SSED BY
CONTRACTOR L.-e ,�` �, i7 "'M __^*+
— - = — �__.
f
, ,. < � CONNECTION DATA
ADDRESS
CITY ,,,. TFL. NO. �'r STATION DEPTH
L� STAE: MANHi Q._. RE.FE RENO ___PPE R__
REGISTRATION NO ❑ COUNTY > IOW.R
hl O. { GESC.RI P7iON CSF
-WOR K FEE {�' TYPE o ^r,ONNECTiON LENGTH FROM
HUS SEWER. OHNE T[Nc,70 I Y. CL(RS P.L. M't TO P I_
PUBLIC SEWER @ $5..08 __—.___..__.__—__ —___. _.—__._
PITS I T ATNF! PIT OR- p. .tOS NO. O
I .S, tAINF!ELD � $f0.D0 I � CO. iM. NO.
HOUSE SEW LR CONN c_.IP4G TO '� —'Y-____
TP,i1 N'F.PE RR9!T N9. ROAD PERMIT NO. _
PRIVATE DISPOSAL SYSTEM @ $3.00 �§-�� TN
e,
C 1NNE!_-T Ail CITION AL BLDfi C.R AF DAVIT ! wnsvcxl EtSENE IT.RE G.QRI3. INSTt�i.NO. DA'?'E
WORK TO HOUSE,SEWER �' 53.00 I I I ✓"
G\.Rr_OV4 SEEPAGE PIT,DRA!NFIELD +"
EXT" CESSPn O'_.0R-WELL,MANHOLE@ 55.00 y �
iWY. OR ST.W!DENOG10
ABANDON HOUSE - \
9�191FLMrdft UISP05At SYSTEM 5_x.00 � i ---__ ____ ________._---._ __-- �___—
__.__ _. 7-
STATE.cNCRCAC,Y(M ENT \ .-..o..
FERMiT NO
INDUST AI.:
WASTE AFfPROVAL
®YY lY GeSie7 2� OC3� f---- CHARGES
AUTHORIZATION TOTAL'.F�E- � �_4i �✓"�`P V��ECT ION CHA Rc E'FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- P/�sRE MBUR EMEP7Y FEE
TRACTOR TO CONPJ'ECT THE ABOVE DESCRIBED EX.iSTING DWELLING .--.--._.___—__---_—___—_..
TO THE PJBL IL SE Eft APPROVALS DATE INSP F.C76R S SiGNA+.liRE
SiGt"!E[: TH(S DAY OF �----19`- - ------- ---------�— ----r— -- ---
t.
i
ON'N,..R OR ,,j NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
s' r'_ - gY f" ✓ BUILDING OR WORK
_-- __ _ _—,
.�GflT'IC TANK,SEEP,PiT(bl
Al
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANDIJR DRAINFIELD I
i
AND STATE THAT THE ABOVE !S CORRECT AND AGREE TO COMPLY -
WITH ALL COUNTY ORC!NANCES AND STATE :.AWS REGULATING
-
PLUMSINC, AND SEWERS CESSPOOL l� DRYWELL
1 HEREBY CCRTtFY THAT I AM PROPF_RLY REGISTERED AND,,OR ALTER,REPAIR.SEWER OR,-- - ---— --?J—_`--_--------'_.
LIC
-NSEO AS REOL!.IRED B)' LCS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM '
CALIFORNIA OR THAT AM TWE LEGAL. OWNER OF,�AND YNTEN.D TO _�._
DISCONNECT PLUG AND
RESIDE IN, THE ABOVE. DP�yCRIHEQ RES!DE*3Tf AL "OF, RTY. ABANDON HOUSE SEWER
. SEEP BACKFILL
Pi{(SEPTIIC TANKSSPOOLS
SIGNATURE URE ;�' .-J
OF PERMl7TEE - r
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL FNGINEER
!,
CK. M.O_. CASH
5.C';