HomeMy Public PortalAbout6012 ROWLAND AVE_Sewer__ 3&&-663 11-55 27 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE D ISPOSAL
Department of County Engineer
County of Los Angeles BUILDING � -
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS -
a CASSATT D.. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
-- —- -- —
LEGAL
DESCRIPTION LCT NO `. _ OWNER ¢ f.-,`.,.,_•' � ���^--T--_
BLOCK - MAIL
`fRAC;T ADDRESS ,�.. A' rl?�r
No.Or B L D G S --- --- - -.-.-. f, �-
SIZE OF LOT-' '`� _`° NQW ONLOT CITY - TEL. N0.
USE OF
BUILD NGS '. DISTRICT NO GROUP MAP
CONTRACTOR "- ,�' 'X • - I i--"
ADDRESS
CONNECTION DATA ------
CITY TEL. NO. s _STATIONI 1,2 DEPTH
MANHOLE REFERENCE - i --UPPE -
GD STATE -
-
R'EGISTRATIONNO. -- --�T� .;� COUNTY
NO. i DESCRIPTCON OF WORK FEE ------ ---- -''i- -- �----
'"'� - - -- �-- ---- - --- TYPE OF i"G,TION LENGTH FROM
hOUaE SEWER CONNECTING TO Ya CURB P L. M.L. y
! PUBLICSEWER -- ---�` n $3.50I 2 �.. O P.L.
,4. ---- ----
SEPTIC TANK,SEEPAGE PIT OR ---
! P1fS AND/OR IRAINFIELD in- 53,00 ----- _ _ _-
T _ -ERFL6111 ------ - --I --'-- -- --' --
6-ERFLO11 SE�'PAGE PIT DRAINF!ELD ,-,;: P C N0.
,r'
iXTN.,C8$$POOL,LRYWELL,NIANHOLE k, $2.00 CO. IMP. N0.- C- JOP N0.
-HOUSE SEWER CONNECTING TO _ _I .___ ----- -- -- -- -.—.-�—.
PRIVATE DISPOSAL SYSTEM �c;. $1.00 TRUNK PERMIT NO __- ROAD PERMIT NOV _. ---
CONNECT ADDITIONAL BLDG,OR STATE ENCROACHMENT
WORK TO HOUSE SE4lLR (n- $2.00 I �' pt PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE - ----- - --- -- ---- -- --
SEVER OR DISP03AL SYSTEM Jai $t.UO INDUSTRIAL --... — _ .-----
..__ --- _. WASTE APPROVAL
CHARGES
---- -_----- __._ CONNECTION CHARGE FEE -
OWNER'S
PERMIT S it 00
AUTHORIZATIONTOTAL FEE E11:3LRsEMENT FEE
�� `i
i SPR®V
I HAVE A7 THIS DA`I'E.A CONTRACT W111-1W111-1A DATE IIh PECTOR'sstGN.ATuRE THE HEREIN NAMED CON- -----__._—.-_-- I_
7RAC'f rP, TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I
TO 'EHE PUBI_I SEW1-R -'- _ NEW HOUSE SEWER -
SIGNED THIS. DAY CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK -
a>1YNE'R5 AGENY � f -----__--
s I
SEPTIC TANK,SEEP,PIT(SI
ADDPESS : d P r �, ry AND/OR DRAINFIELD __.....---�'-----------------
I HEREBY ACKNOWLEDGE THAT, I HAVE READ THIS A.PPLIC4tMN 1
AND STATE THAT THE ABOVE IS CORRECT. AND AGREE TO COAPLY . CES5POOL I✓ DRY1^JELL 0 -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING. .ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. -' SEWAGE DISPOSAL SYSTEM
I EiERE6'd GER I i Tr;T I A PROPERLY REyfSTERED AN'D,,'OR DISCONNECT FLU AND i-
LICENSED AS rF uI EL BY:LOS ANGELES COUNTY AND STATE OF i
CALIFORNIA OR TI AT 'AM THE LF IIS ?1WNER THE ABOVE AUAGOON MOUSE SEWER_
DESCR P,ED RESIDE'NTIAk a"ROPF.RTY d: RACKFILL SEPTA'TANTS
SIGNATURE `< -' "`. SEEP. PIT IS) a CESSPOOLS ILI
OF PERMITTEE
I
TONY+!A. LAMBIE, COLXNIfiY ENGINEER .-� IJ*7 � (� y ROBERT A. WO01),CHIEF PLBG, INSPECTOR
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