HomeMy Public PortalAbout6032 ROWLAND AVE_Sewer__ Dl,PARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENI3INCER BUILD!GGAD 1)RES
f
FOR APPLICANT TO FILL IN LOCALITY &2_
BUILDING NEAREST
ADDRESS J'., CROSS ST.
LOCALITY _ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST `
CROSS ST. — --
RECEIVED BY` Ready for Inspection DATE ISSUED
OWNERMAIL
�.EJT
ADDRESS i= P USE ZONE OCCUPANCY BK M"PG"
CITY TELAO. " "_ L?
CONTRACTOR .,w+ 4-'4 r :: ..3 srg r c.. CO.IMP.NO. /
ADDRESS �:.:- �# yr�� C Lfi
JOB.N0.
CITY TELAO. -
y'r ".S TRUNK PERMIT NO.
STATE
REGISTRATION NO. a aM COUNTY �n
�s ROAD PERMIT N0. ! �
LEGAL1 $ _ r_° Fg 1 STATE ENCROACHMENT
DESCRIPTION LOT NO. sr . ( PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL - `-`-
SIZE OF LOT NO.OF BLDGS. CHARGES
NOW ON LOT
USEOF
_
BUILDINGSt,.. "` "' / CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT F
HOUSE SEWER CONNECTING TO f
PUBLIC_SEWER @ $ 3.50 r' RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 _ CONNECTION DATA
E
SEPTlC TANK,SEEPAGPIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
—SPECIAL CONDITIONS
G 1 MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.00
Z, UP?E.R=-> LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 Y. CURB P.L.— M.L.TO P.L.
AUTHORIZATION I TOTAL FEE `
1 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
1NEW HOUSE SEWER
SIGNED THIS.........::::......DAY OF..._ -.
".... � �-...
. ..... :.
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.........._. w.,. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..-_:..------------------------... ......:-...--._-._........c........................... AND/ORDRAINFIELO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL L7CATION 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 _
I HEREBY CERTIFY THAT ( AM PROPERLY REGISTERED DISCONNECT PLUG AND
ST
AND/ LICENSED IF REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)D CESSPOOLS❑
SIGNATURE
OF PERMITTEE--.° -------------
i
7GA642A 663 7/53