HomeMy Public PortalAbout6218 ROWLAND AVE_Sewer__ 8 8.E463 92.54 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DlSPOSAL
Department of Couxaty E��inserIMMUMM
County of LOs Atltf#3�ei BUILDING ,
WM. J. FOX, COUNTY ENGINEER ADDRESS ' r
CASSATT 0.GRIFFIN. SUP"r or BUILDING LOCAL&TY µ
FOR APPLICANT TO FILL IN NEAREST
_ _ CROSS ST.
LEGAL - - ----�-- - - -- .--. -. ___
DESCRIPTION LOT NO. 6WIYCR
SLOCK TRACT MAIL _
_ADDRESS
NO. OF SI DGS$175 OF ilF LOT_ .......<e...-NOW ON LO! 4 CITY T,._L. N6I.
USE OF
BUILDINGS ..- _...- DISTRICT TO, GROUP 1 NAP 0
$ i UK PG t
CONTRACTOR -
ADDRESS CONNECTION DATA �.._._..�
CITY TEL.NOS - - . STATION Dr P'rl-I
STATE M MANHOLE REFstr { E
`.:
REGISTRATION N4. COUNTY _ _ _ UPPER
TYPE OF CONNECTION LENGTH t'ROM
P±O, DESCRIPTION OF WORK FEF..
HOUSE s Ewd" CCN ii E 6 Y f NG
PUBLIC 5 cR '�S_a 50 .
HOUSE SEWER CONNECTING TO
PRIVATE D1SP0-=AL 5Y$TEIA _ 1,00 I - --s - - -
CONNECT ADDITIC AL BLDG. OR - ---��—_+—. CO, 1AfP, NO. JOB. No. '
WORK_TQ Y ULSE SEI R t 00 _ .__;..—�..�.. .__..e._ .._-._..._.
ALTER OR REPAIR EXISTING
..EWER 0P V1SP O 5 A L SYST ES; i 00 � i TRUNK rfPMIT NO. ROAD PERMIT NO.
DISCONNECT c AND ABANDON SEvwER
FATE E€ ROACHMENT
AND/OR DISPOSAL rISPOSA STEM __ 1.00 _ .._.. PEI AFT NO
�i SEI I'TANS SEEPAGE PIT OR � .. -
PIIS AN /OR GRAIN} LD .d 2.00 j w INDUSIWAL c
1 CESSPOOL 'DRYWELL }
E"� --- NIASTE APPROVAL
SAF C!AL GO tiC TONS
ONLY >.00 i - CHARGES
� I �
PERMIT CONNECTION CHARGE FF
OWNER'S __ , 111 00 t
AUTHORIZATION TOTAL Fn --- � �� I �" REIR78� s�I,z.,T FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS
��% -TRp�e
TRACTOR To CO�€NECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE iNSPECTOWS57GNATUPE
TO rraE PUBLIC SEWER _.
SIGNED THIS-DAY NEW xousE 5 4,ER
OWNER. OR ' CONNECT ADDITIONAL
BUILDING OR WORK _..._.
OWINEftS AGENT_ ..._ -
< ASEPTIC TANK, SEEP, PIT(S)- B
AND/OR DRAi1 FI.FLD
a€ HEREBY ACYNOWLELIGE THAT I HAVE READ THIS APPL.CATION CESSPOOL El DPYWELL[IAND STATE STATE fHAI 1 41E ABOVE IS CORRECT AND AGREE To CON-PLY
WITH ALS. COUNTY ORDINANCES AND STATE LAWS REGULATI17]G " ALTER, REPAIR SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL.SYSTEM
I HERESY CE'RTI;"Y THAT ! AM PROPERLY' RECISIERED AND! DISCONNECT PLUG ANDP.V..�_ — - - --
LICENS'ED AS REQ� IPED BY LOS ANGELES COUNTY AND STATE.
CALIFORNIA OR 'THAT I AM THE LEGAL OWNER CP THE ABO _ABANaGN HOUSE SE'eYER _ _
DESCRIBED RESIDENTIAL PROPERTY.. BACKFILL SEPTIC TANKS[3 ..��
SEEP.PIT(Si CESSPOOLSCI�
SIGNATURE !
OF PERMITTEE.--
WILLIAM
ERMITTEE._ - - - p&&&p
�N I
WILLIAM J. FOX,COUNTY ENGINESR VALIDATION
BY 1.3 BY
DEPUTY DEPUTY
BY 9Y
DEP'JT'Y .. DEPUTY