HomeMy Public PortalAbout6037 ROWLAND AVE_Sewer__ 96A842D APPLICATION FOR PERMIT - 1.
CR8A8-8.58
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING a✓
rolfrl A. T AMBIE, c®uneYgln®ar ADDRESS
CASSATT D. GRIFFIN.Sup't of Building LOCALITY "
NEARESTFOR APPLICANT TO FILL IN _CROSS ST.
LEGAL xi
DESCRIPTION LOT N0. '' +: f 3 �, �` OWNER ,X;C>�G t�✓ ;
BLOCK TRACT MAIL
- ADDRESS
NO,OF BLDGS.
SIZE OF LOT '_2 fir; NOW ON LOT CITY TEL.N0,
USE
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
t'•%. 'g=T,K---`-�"
CONTRACT07T f - rw a BK / PGS
LE
ADDRESS CONNECTION DATA r
CIEL.NO j g "Yr ;. i` STATION —/- .y ;,7 DEPTHSTATE
E{ a
REGISTRATION NO. ✓ T + COUNTY MANHOLE REFERENCE !d UPPER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $9.00 jsye" —
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONN ECTION LENGTH FROM y
PITS AND/OR DRAINFIELD @ $9,00 Y. CFIRB,I., P.L. M.L.TO P,L.
OVERFLOW SEEPAGE PIT.„DRAINFIELD
EXTN.,CESSPOOL,DRYWEI.L,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO - P.C. N0.
PRIVATE DISPOSAL SYSTEM @ $1,00 CO.IMP.N0.
CONNECTOUSE SEWER AL BLDG.OR
WORK TO HOUSE @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0. - .CJ
ALTER., REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 'ERMIT NO.
NDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 C10 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE +` ",7� REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS BATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUB"LIG SEW� y
SIGNED THIS ) `P AF T(g NEW HOUSE SEWER ---
OWNER OR Jf ` CONNECT ADDITIONAL
OWNERS AGENT `� BUILD!NG OR WORK
SEPTIC TANK,SEEP,PITS)
ADORES f AND/OR DRAINFIELD
I HEREBY ACKNOWL OGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATELAWS 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT! "'PROPERTY. -_ BACKFILL SEPTIC TANKS❑ -
SIGNATURE SEEP,PITS) Q CESSPOOLS E
OF PERM,ITT
LL �� �'
VALIDATION ROBERT A.WOOD
6K. Y.O. cult SUPERVISING MECHANICAL.ENGINEER