HomeMy Public PortalAbout6234 ROWLAND AVE_Sewer__ E-663- APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL.
Department of County.Engineer
County of Los Angeles BUILDING ,,
'tNM..J. FOX.COUNTY ENGINEER ADDRESS
CASSATT®.GRIFFIN,SUP'Y OF'BUILDING LOCALITY
FOR MPLICANT TO FILL INNEAREST
.LEGAL
CESCRIPTCON LOT N9_- OWNER
BLOCK TRACT MAIL
N0. OF BLDG$,
SIZE OF LOT _ NOW ON-LOC .�_ CITY TEL. N0,
_
USE OF -- milli
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PL'LCItdGS DISTRICT NO, GROUP r MAP
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CONTRACTOR /_
ADDRESS - CONNECTION DATA
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(D. STATE
MANHOLE!n REFEREtd Cs �.-UPPER-
REGISTRATION NO. ' [] COUNTY -
h0J DES RIPTION OF WORK FEE
TYPE O=CONNECT LENGTH rRC,4,f._
HOUSE SFW-R CONN C'NNG TO I -
- IPLI�LIc SrWYL-,R (t1 $ 3.50 1
- ! Y.. CORE B P' --M L. TOP L ,
HOUSE -SEWER CONNECTING TO `
,1PRIVATc C1. POSAL SYSTEM 1.04 f f -.-�-.-- --------- --_.---.�
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r G''i°`':iV ECT A JiTI�gzAI BLD;;. UFt -I P C. NO.
WORK
--� ORK TO HOOSE k V R Lao � COO IMS NO.ALTER OR OR REPAIR EXI YIN - --
} SEWER OR DISPOSAL SYSTEM i.OG I � TRUNK PERMIT NO, ROAD PERMIT NO,
LIS OM'vs r FSC ABANDON SEWER
P : DISPOSAL Y CIi 5lNT.Ai TliFSTENCROACHMENT
S_iff� S ,ERF,1II NO
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; PITS AND/OR CRIFIEID
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CESSPOOL UN.FM ELL
SPECIAL COI is NO dS ONLY CKA R'' ..=
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CONNECTION CHARGE FCL"
$ "I
OFR` PERMIT i I 0) -- - -- - -------_---- - -
AUTHORIZATION TOTAL FEE I �
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CA CONTRACTED r,1TH th6 H.^._.-R-EoIN hA-W-EU 0d`
? T _ A—P—PR..—O.V._A._L._S.._
DAr- dPFtTk4'f0 TvCONN' _ VGlpTOR .._`-G-NAT-UR--E
TO 7 s PUBLIC -
SEWER �—-- —
.. NEW HOUSE SEWER
SIGNED T7-if3 `.DAY QF--_.'— ��1�r
CONNECT ADDITIONAL
OWNER C R i ----�--.-__
OWNERS AGf�.�'.T_._.-. .w: BUILGING JR`NOFK
___._-- _-._..._..-_ .----------------- SEPTIC TANK{ SEEP, PIT(S)
ADDRESS. _ AND/OR ARI Ii LLD
ANI H EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION --OOL[J- D
S ATE ,1HAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CFSSPOL[I RvbVELL� ^� }
W 111 ALL COUNTY ORDINANCES A14D STATE LAWS REGULATINI; ALTER,REPAIR SEWER OR
PLUWSrs[tIG AND SEWERS, ALTER,
DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED ANC OR ---
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND `'TATE OF .DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANCON_FiOUak SE/•"ER _
DESCRIBED RESIDENTIAL PROPERTY'.. BACKFILL SEPTIC TANKS❑
(sC.EsSPOOLS t� I
SIGNATURE ._gEP. P€r._) 0 _�.__._._ ..�. _.._,_._..
OF PERMIT rE.—_ -
®NILLIAIYI J.FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FL.8G. INSPECTOR
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