HomeMy Public PortalAbout6052 ROWLAND AVE_Sewer__ I DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM. J. FOX, COUNTY ENGINEER BUILDING
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BUILDING CROSS ST.
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LOCALITY DISTRICT NO. SERIAL NO. PERMIT N0.
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CROSS ST. II ; /' REECC�• ED,B I Ready for Inepeallon D TEAISS:EDOWNER � �T
MAIL ,pp USE ZONES OCCUPANCY ! �YIAP
ADDRESS q g�+ A,¢#� J R BIC PG
CITY /' ; _ TEL.NO. /< - • • I ��
CONTRACTOR � � A,1519616,le CO.IMP.NO.
ADDRESS d �. � ✓ 4 13J V-0- JOB NO. ti
CITY �'l�� TEL.NO. -ST11' TRUNK PERMIT N0.
REGISTRATION NO. ,���. NTTY -�
ROAD PERMIT NO. �, 7
e u�_
LEGAL &� �3d- I
DESCRIPTION LOT N0. _92 f1 t PTATE
ERMIT NOROACNMENT
BLOCK TRACT G CD / INDUSTRIAL
_ q WASTE APPROVAL
NO.OF BLOG
SIZE OF LOT' Bx�� NOW ON LOTS.
/ CHARGES
USE OF
BUILDINGS /1 [l! �,� � �� _ CONNECTION CHARPE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
_POHOSE SEWER CONNECTING TO C�
S SEWER @ $ 3.50 1 RECEIPT N0: I DATE BY
HOUSE SEWER CONNECTING TO I
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RikORDED
WORK TO HOUSE SEWER 1.00 :O I '
ALTER OR REPAIR EXISTING NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00DISCONNECT AND d!
AND/OR DISPOSAL SYSTEMN SEWER 1.00 CONNECTIONDATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 0STATION J T� . DEPTH
SPECIAL CONDITIONS ONLY 2.00 MA H04E. EFERENCE��� f
UPPER O ,/w/✓. '
TYPE OF NN CTION LENGTH FROM •�-�
OWNERS PERMIT I 00 `'•�RB) �-i.: M.L.TO P.L. v�
AUTHORIZATION I TOTAL FEE.
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABO. E DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWE r
I J / NEW HOUSE SEWER ry�y
SIGNED THIS�.__.....____DAY OF._.:..�__.M._�...._.�_..19 T: • !I A_ _P�� �i'.�
OWNER OR ( CONNECT ADDITIONAL
OWNERS AGENT.......f• • BUILDING OR WORK
ADDRESS..__._..... Z-- f 'f..+ SEPTIC TANK,SEEP.PIT(S)
} r•--• f- -'.-- ------•---•-----••-----•-'�- AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- .CESSPOOL[] DRYWELL
CATION 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED.AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIRORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED.RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE f r frr _ SEEP.PIT(S)E] CESSPOOLS (J p�I SJ
OF PERMITTEE. l--- 00'�- �
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