HomeMy Public PortalAbout6018 ROWLAND AVE_Sewer__ DEPMtTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER ADDRESS
S
} ss
FOR APPLICANT TO FILL IN LOCALITY
BUILDING //��r ' NEAREST {t
ADDRESS ti!JC ,,S,L �r CROSS ST. ti ct �' q
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST f s "J
CROSS ST. RIECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL ADORES USE ZO OCCUPANCY MAP
_ S �# °+�, �:, BK PG
CITY j TEL.NO. _ ( '
CONTRACTOR
CO.IMP.N0.
ADDRESS J. � JOB NO.
CITY i�r��l� «✓ �TEL.NO. TRUNK PERMIT NO.
6 STATE
REGISTRATION N0. ® COUNTY ROAD PERMIT NO.
LEGAL , STATE ENCROACHMENT
DESCRIPTION LOT NO. '-% PERMIT N0.
BLOCK TRACT � 1 I INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �C) NOW ON LOT
N0.OF BLDGS. �. CHARGES
USE OF wi• ,t
BUILDING$'� ,5/ �'_*�� _'; } CONNECTION CHARGE FEE
.r
NO. DESCRIPTION OF WORK FEE
— REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO ,
/ PUBLICSEWER @ $ 3.50_ RECEIPT NO. DATE (BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
WORK CONNECT HOUSE SEONAL WER BLDG.OR i 00 EXCEPTION RECOR 6D
ALTER OR REPAIR EXISTING
N0. DATE BV,-
_
SEWER OR DISPOSAL SYSTEM L00 I I `
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR -
PITSAND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 i MAAIFtDREFERENCE
UPPER,
_ TYPE OF .DNNECTION LENGTH FROM r
I-- d I y (9{K M.L.TO P.L.
OWNERS PERMIT # 11 00
AUTHORIZATION ( TOTAL FEE '
I HAVE 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_.,&e_&DAY OF.. ___-......Iq_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..... �."..--...._._---.--- -. a'_. BUILDING OR WORK
ss � SEPTIC TANK,SEEP.PIT(S)
ADDRESS_- ........ _:-. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CAT
ICN AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATSNG PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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
>") SEEP.PIT(S)[:] CESSPOOLS Q e- �>`f r
SOF PERMITTEE.. }...
76A642A 663 7/53