HomeMy Public PortalAbout6205 ROWLAND AVE_Sewer__ IDE+'PA4iTDIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
+ WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS J/ ~�
FOR AILDINGPPLICANT TO FILL IN LOCALITY Z�/`•.
NEREST
ADDRESSy,/ CROSS ST.
LOCALITY pp � ) DISTRICT N0. SERIAL NO.f PERMIT NO. C
CROSS ST. 1 ' 4 A I I k FIS /� r/ J
J RECE ED BY Ready for Inspection DATE ISSUED
OWNER 14/ ..�. _ y .7y 33
MAILS `
ADDRESS07 5j )'. `i` USE 2dNE OCCUPAAIC MAP
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CITY C• TELAO.��r/m
CONTRACTOR
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ADDRESS1'� D
JOB.NO.
CITY �_x F/sp TEL.NO./,,A,
TRUNK PERMIT NO.
STATE
q
REGISTRATION NO.;/ dye COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. 1 STATE ENCROACHMENT
0 o 2. PERMIT NO.
BLOCK TRACT r ASTE TRIAL PROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF 4
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO _ REIMBURSEMENT FEE.
PUBLIC SEWER 0 $ 3.50 RECEIPT N0. I 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. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION ` ��. DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REF CE
". RR 51 (,,`I_.__ LOWER
TYPE OF CONNECTION LENG1
OWNERS FROM �•
PERMIT $ 1 00 Y" ---'G(*a P.L. M.L.TIO P.L. 3 S
-
AUTHORIZATION TOTAL FEET
I 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
SIGNED THIS.___..___._.._DAY OF_..___ ._._.__.19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.. _.__._.._.......__._.._..._._._.._._..._............ _ BUILDING OR WORK
ADDRESS............................ SEPTIC TANK,SEEP.PIT(S)
_..._.....__.__..___...._....__......._.._..�-.•.-•_• AND/OR DRAINFIELD
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRI ED'RES D NTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)o CESSPOOLS O
c
OF PERMITTEE_
T6A642D 663 1/53