HomeMy Public PortalAbout6043 ROWLAND AVE_Sewer__ 6AB42 �-F� APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL,.
BUILDING AND SAFETY DIVISION TAUDRFS5
DINr f,._
JflFIN A. LAMBI£, County Engineer
WILLIAM A. JENSEN. Supt of Building L LOOCALITYRE TF'OR APPLICANT TO FILL IN �S T '� I� � ''��� � f.
DESCH F'7ION (.STS OWNER
MAI
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BLOCK 7rcAC7ADDRESS -
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NO OP BLDGS. J
SIZE OF' LOT NOW ON LOT CITY 'rEL, NO.
E OF
BUILDINGS D STRICT NO, ROUP MAP P}.QC£55E,.D 8Y
CONTRACTOP
ADDRESS ' �- CONNECTION DATA _ - — --
- - — - -
-- ON
DEPTH �!
T (�=' _ .__ — *'"STATE.._- MANHOLE REFERENCE
R:UiST RATION J -, COUNTY
OWER
'+,O F E.C'f�IPY1ON Of WORK FEE
-_. TYPEOF CO -'^C--ITiON LENGTH FROM
NO-
Y '"R1 M.L TO P_
SEWER CONNEC SINGTO
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oo_
P SEWER JNO-
-4-SEPTIC
r5 P I T iK SEEPAGE PIT ORC06IMP.
ADD ,>R D AIN IFLD n $ O(10 r v OB NORE i '
ON _ TRUNK PERMIT NO. ROAD PERMIT NO.H05E SEWER.. T .
tivATE DISPOSAL SYSTEM $3.00 'i
- --_.. ___._______.r__,_ T_—__
C'ON 7�-G"ADU .;ONR BLDG:OR AFFIDAVIT 1 WAIVER EASEI EI.T 7 RECORD.:NST'R NO. DATE ?'
WORK TO"OUSE SEWER & 33.COUJ
f
OVER--OW rEPAGE PIT,DRAINFiELa
EXTN YS i OQ!_,DHYWF'L L,MANH O LE. $5,00 HWY.OR ST.WIDENING
AI E,3 AIR OR ABA NC7'OFv 1FUSE.--
SFF{F'R OR D)SPOSA SYSTEM ��` $3.00'
_.. ENCROACHMENT
PERMIT NO,
NDUSTRiAL.
WASTE APPROVAL
OWNER'S PERMIT _ �?-__ 2 Oo -- -- __ CHARGES ----- ------.
AUTHORIZATION i TOTAL FES__-__ -I � _ CONNECTION CNA.RGE FEE
REIMBURSEMENT FEE
'I HAVE Al THIS DATE A. CONTRACT W'{TH THE HEREIN NAMED CON- -.__.___ .___._..__
[TRACTOR *10 CONNEC,7 TP"- ABOVE DESCRIBED EXISTING DWELLING.
TO THE UL Ic APPROVALS DATE _INSPECTOR-S SIGNATURE:
SIGNED Y
OWNER OR �'.Y�.. 1`It WNOL,E.SEWER
OMlNER.s
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
_ --_ _-. __ -._.-- --.- SEPTIC TANK,SEEP P!T(S) �—
I HEREBY A KNOW!-CL) THAT HAVE READ THIS APPLICATION AND,OR ORA.INFIELD
AND TAT THAI r_. ABOVE15 CORRECT AND AGREE I'D COMPLY
W.?TH AIA. COUNTY ORDINANCES .AND STATE, LAWS RF_GLLATING
PL PL"
N�� AND. SEWERS. CESSPOOL DRYWELL
I HEREF3Y CERTIFY THAT I AM PROPERLY REGISTERED AND;OR .ALTER,REPAIR,SEWER OR ---- j _---�--i---__lT
LIC€NS'ED AS Y RE qt
;RED BY LOS ANG'_.ES COUNTY AND STATE OF - SEWAGE DISPOSAL SYSTEM '
CALIFOP N'A AOR 7H AT I. AM THE LEGAL OWNER OF AND INTEND TO ___._ .._. ._._-___—.-1 ---.—
RES?DC ,N, TME V€, D.E .RiBED RESIDENTIAL. PROPER;-Y.
DISCONNECT' PLUG AND
ABANDON HOUSE SEWER
S'GNATt RE
OF PERMiTTr___ _ .. F }� --���® 9 is�„ BA K'r'I LI_SEPTIC TANKS -
--- -�1r- ,e"r✓�c �Yrb SEEP,PITS) ❑ CESSPOOLS j
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. s� M.0, CASH t
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