HomeMy Public PortalAbout6033 ROWLAND AVE_Sewer__ D
-808- APPLICATION FOR -PERMIT 1
, eos-e-se COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 1, _' %
JOHN A. LAMBIE County Fmg9n®er ADDRESS
CASSAIT D, GRIFFIN, Supt of Building LOCALITY 'L
NEAREST
FOR APPLICANT TO FILL IN
CROSS S
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL I' :�41
ADDRESS G u-';L�__
N0.OF BLDGS,
SIZE OF LOT NOW AN LOT CITY TEL.NO.
USE OF �1.
BUILDINGS ` L t.. ':t c DISTRICT NO, GROUP`y ASAP PROCESSED BY
CONTRACTOR p ggg� gt [a
ADDRESS
PG
"a
ADDRESS 840 Seg, Ploldvhn Avenue _ CONNECTION DATA
CITY Arcadia, C yNo- Hf 7-0882 STATION DEPTH
STATE UPPER
MANHOLE
REGISTRATION NO. f__ COUNTY LOWER
NO. I .DESCRIPTION OF WORK' FEE
HOUSE SEWER CONNECTING TO _ p
PUBLIC SEWER @ $8.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC NK,SEEPAGE
PITS AND�OR DRAINFIELDT 0R @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
£XTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR p TRUNK PERMIT N0. ROAD PERMIT NO,
WO-RK TO HOUSE SEWER Cg $1,00 'y�
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEiVER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE "xI s'�"' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. -"
SIGNED THIS ` AY OF Jg NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGE IT ` f BUILDING OR WORK T
SEPTIC TANK,SEEP,PITS)
ADDRE55' s ' r- � �� -✓ AND/OR DRAMFIELD
I HERERY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALI. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT (t-AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAIi kOPER Y BACKFILL SEPTIC TANKS[I'fir
SIGNATURE SEEP.PIT(S) CESSPOOLS
t �° � ✓ �%�- w
OF PERMITTE
'Y,,i DATI0N ROBERT A.WOOD
l6tC>R M.* t ABIf SUPERVISING MECHANICAL ENGINEER