HomeMy Public PortalAbout4904 ROSEMEAD BLVD_Sewer__ ° APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
D"x-ft-nt of CooniT Engh~ y� /ny
�T of I'Of �M ADDRESSgfnz 6 1/ ,✓ U
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATTD. GRIFFIN, SUP;TOFPUILDINO LOCALITY
FOB,APPLICANT TO FILL IN cROBa BT. N
LEGAL OWNER (J E S L
D CRI nON LOT N0. fi
MAIL Y
BLOCK TRACT - ADDRESS
NO. OF BLDGB. FITY L TEL. NO. - /
SIZE OF LOT NOW ON LOT
USE
OF
BUILDINGS DISTRICT NO. GROUP YAP
BUI
BK PG
CONTRACTOR
CONfC=ON DAM&
ADDRESS
STATION DEPTH
CITY T>iL NO. kAJIHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRAT N N0. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER S 3,50 Y. CURB P.L. Y.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD B 9.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0.
EKTN.,CEJSSPOOL DR ELL MANHOLE 2.00 CO. IVP. N0. JOB NO.
i HOUSE SEWER CONNECTING TO
i PRIVATE DISPOSAL SYSTEM 8 j 1.00 TRUNK PERMIT N0. ROAD PIERNIT NO.
COXNECTADDI MOXA BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE
SEWER @ f 1.00 PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM I,p0
HASTE APPROVAL
C HAl2 O[3
CONNECTION CHARGE FEE
OWNE'B'8 PST 1 00
AUTSOBIZATION Tb AL FnREIYBUA3EYENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX- AFPBOVAM DATE INSPECTOR'S SIGNATURE .
TRACTOR TO CONNECT THE ABOVE DESCRIBED U19TIMO DWELIIXG
TO THE PUBLIC Ii EWER. ' NEW HOUSE#EWER
SIGNED THIS SAY OF ISt CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGHNT SEPTIC TANK,SEEP,-PITS)
ADDRESS AMD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR DIO0XNECT PLUG AND
LICENSED AS REQUIRED BY LAQQ��
03
NGELES COUNTY AND STATE OF ABXMDON HOUSE SEWER
CCJ9IFORNIA OR THAT 1 AY THE LEGAL OWNER DF THE ABOVE
D(:SCRIBED RESIDEN IAL PROPERTY. _ BAWILL SEPTIC TANKS❑
SIGNATURE St-EP.PITS) ❑ CEss POOL8 l\
OF PBRYI
JOHN A. LAMBIE, COUNTY ENGLNWER ATI ROBERT A.WOOD,CHI"PL-80. INJ4PECTOR
4942E-; 4 2.00 10
APPLICATION FOR PERMIT
■i 4117 7-t■
Drf=ON.OF BUMDING AND SAFETY SEWEREWAGE DISPOSAL
Dwpmtnant of
- (o=±r of BUILDING
WM.J..IFOX, COUNTY ENamacm ADDRESS O '
CASRMTT D.11RIMN,*up-.of■ummrms LOCALITY
FOR APPLICANT TO FILL III NEAREST
CRQU 5T,
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT 'MAH.
ADDRESS
NO. OF BLDGS.
E1ZE OF LOT NOW ON LOT CITY TEL. N0.
USE OF
(-
0.DISTRICT NO. GROUP MAP
E�iy.,-�T I M 7
BK PG
CONTRACTOR Vim
T)
d. CONN=ON DATA
CI TEL N y STATION �. DMH ,
ATE MANHOLE REFERENCE ti/�/ '
REGISTRATION NO. ❑ COUNTY v�� L01,'ER
No. DESCRIPTION OF WORK- FEE
TYPE OF COXXECTI LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P. Y.L.TO P.L
PUBLIC SEWER 3.60
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT A DITION L BLDG.OR P. C. NO.
WORK TO HOUSE SEVER 1.00 CO. IMP. N0. JOB N0.
I ALTER OR REPAIR KXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERM 0.
" DISCONNECT AND ABANDON SEWER STATE ENCROAC
AXD/OR DISPOSAL.SYSTRY 1:00 PERMIT N0.
1 EPTIC TANK,SEEPAGE PIT OR
ITB MD/OR DRAINFIELD ,00 INDUSTRIAL
CESSPOOL-DRYWELL WAM APPRQVAL
SPECIAL CONDITIONS ONLY 2.00 RANGES
CONNRCTION CHARD E[
0�$'$ PEI3I� S 1 00
r
AUTHORIZATION TOTAL FlM REIMBURSRYRX FEE
I HAVE THIS DATE TO CONNECT THS ABOVE DESCRIBEDCTED WITH THEHERE1N NA W CON-
TRACTOR AMOVAIS DAME INSPECTORS SI@IIATURE
TO THE PUBLIC SEWER
SIGNED THIS SAY OF NEW HOUSE SEWER � .
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUIL IXG OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ TH19 APPLICATION CESSPOOL❑ DRYWELL[IAND STATE THAT THE ABOVE IE CORRECT AND AGREE O GO LY
WITH ALL COUNTY ORDINANCtS A D STATE LAWS EGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SL7ERD. SEWAGE DISPOSAL SYSTEM
` 1 H CERTI THAT 1 A PROPERLY REGI ED AND/OR
LIC S REO RED BY LOS MGE DUN TY D STATE OF DISCONNECT PLUG AND
CALIFO NIA OR 7HAT I AM T R LIG THX ABOVE ABANDON HOUSE SERER
DES CAI I NTIAL PR P BACIFILL C TANKS 41
BEr ITE CESSPOOLS 0 1711
SIGMA
OF PERMITTEE
WILLIAM J.FOX,CouNTY FNaINEx VAI=T= R.A.WOOD,CIIISF PLwa. INSPI CTOR
:i C; JrL _ 4 4 4.5 L
1