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Home My Public Portal About4932-34-34 1/2-36-36 1/2-38 ROSEMEAD BLVD_Sewer__ 76A 6420-GE.'bD8 A-7.76 APPLI CATI FOR PERMIT C -SEWER—SEWAGE DISPOSAL' ~ COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO IN DISTRICT NC�O. GROUP BX MAP PS PROCESSED BY BUILDING �— LOCALITY ADDRESS VV Z ' CONNECTION DATA NEAREST T- STATION DEPTH CROSS ST UPPER MANHOLE REFERENCE -- OWNER TYPE OF CONNECTION LENGTH FROM LOWER MAIL _ � Y. CURB P.L. M.L.TO P.L. ADDRESS za �Z../ /� 1,6rjd_ P.C.NO. ` CO.IMP.NO. JOB NO. CITY 'TEL. NO. LEGAL TRUNK PERMIT NO. ROAD PERMIT NO. DESCRIPTION LOT NO. AFFIDAVIT WAIVES I EASEMENT RECORD.INSTR.NO. DATE BLOCK TRACT NO. OF BLDGS. SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING USE OF STATE ENCROACHMENT ryry� BUILDINGS PERMIT NO. �'�pL / INDUSTRIAL CONTRACTOR WASTE APPROVAL rZ'/ ADDRESS CHARGES CONNECTION CHARGE FEE CITY TEL. NO. STATE LIC REIMBURSEMENT FEE LICENSE NO. CLASS NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE HOUSE SEWER CONNECTING TO PUBLIC SEWER NEW HOUSE SEWERp�,,, ,� W SEPTIC SEEPAGE PIT OR r PITS AND/./OR OR ^_ DRAINFIELD CONNECT ADDITIONAL ��nn HOUSE SEWER CONNECTING TO BUILDING OR WORK ?'.tk�)t' �./r PRIVATE DISPOSAL SYSTEM @ SEPTIC TANK.SEEP,PIT(S) CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD W.OA4Yt7 HOUSE SEWER @ 6 OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL ❑ DRYWELL ❑ EXTN..C_ESSPOOL.DRYWELL.MANHOLE ALTER.REPAIR OR ABANDON HOUSE ALTER.REPAIR.SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS ❑ SEEP.PIT IS) [3CESSPOOLS ❑ . OWNER'S Issuance Fee ICATION AUTHORIZATION TOTAL FEE 5�7 ANDSTATE THAT-THEEREBY OACKNOWLEDGE DBOVE THAT CORRECT AND AGREEI HAVE READ THIS AAT'ON TOL]ANR WITH ALL COUNTY ORDINANCES AND STATE LAWS REG I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. PLUMBING AND SEWERS. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED TO THE PUBLI WER. LCENSED AS RE BY LOS ANGLES COUNTY AND.SSIGNED THI DAY OF CALIFORNIA OR AT I M THE LEGAL OWNER AND INOWNER OR RESIDE IN. THE BmVE DESCRIBED RESID I L PROP TY +'OWNERS AGENT SIGNATURE' OF PERMITTEE 'VALIDATION C�K. M.O. CASH 5.s 1 •�u� g�i -D 1 3.5 a n r � 3-64 76A643-64 APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 4934-423() JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building 49342 2 LOCALITY Temp1p_ City NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL �.y.� K W Jensen DESCRIPTION LOT NO. v/'�. OWNER K.W. MAIL BLOCK TRACT ADDRESS 6556 No.V i s to St. SIZE OF LOT NOWOON LOTS CITYSan Gabriel TEL. N0.286-4204 USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG / v CONTRACTOR Joseph Cadi- 1 l i P l b .0• �d� ..,� ADDRESS 7821 E . GarveyAve CONNECTIO DATA CITY S San Gabr i e TEL. NXU 32842 STATION ` DEPTH REGISTRATION ND.134935C-36 STATE MANHOLE REFERENCE / UPPE COUNTY 41, NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM ` 1 HOUSE SEWER CONNECTING TO 0 Y. CURB M.L.TO P.L. PUBLIC SEWER @ $8.00 SEPTIC TANK,SEEPAGE PIT OR 01ad P.C.NO. 0- CO. PITS AND/OR DRAINFIELD $10.00 IMP. NO. JOB NO. D_ O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (J PRIVATE DISPOSAL SYSTEM $3.00 j CONNECT ADDITIONAL BLDG.OR ) AFFIA DVIT WI11V[R [Ae[M[NT RECORD.IN3TR.NO. DATE WORK TO HOUSE SEWER $3,00 �0' t Q OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN„CESSPOOL,DRYWELL,MANHOLE $8.00 V ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Ud D_ SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT N PERMIT NO. z INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE 1! J• 00� CONNECTION CHARGE FEE CHARGES 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR ACTORT CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TPUBLIC BEWER APPROVALS DATE INBPE TOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER �/'•��0. _ OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.BEEP,PIT(8) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINPIELD WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEW FRB. CESSPOOL [IDRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIREBY LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT M THE LEGAL OWNER I TEN T DISCONNECT PLUG AND RESIDE IN, THE ABO E DESCRIBED R DENT L P Y. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(5) C] CESSPOOLS ❑ (CVALIDATION ROBERT A. woOD K. M.0. CASH SUPERVISING MECHANICAL ENGINEER �1 3-64 76A643-64 APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADORESS WILLIAM A. JENSEN, Sup't of Building LOCALITY / NEAREST FOR APPLICANT TOPLL IN CRDS6 BT. LEGAL _ DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS 1 SK PG CONTRACTOR �� ADDRESS s CONNECT DATA C STATION DEPTH CITY �, � TEL. NO. J STATE MANHOLE REFERENCE UPPER REGISTRATION NO. qfiS COUNTY 'L'L !T NO. DESCRIPTION F WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. CL CL PITS AND/OR DRAINFIELD @ S10.00 Co. IMP. NO. Q' JOB NO. 0 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE DISPOSAL SYSTEM @ S3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 O OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 U rt49'CR-R7•T'RiA+6R ABANDON HOUSE HWY.OR ST.WIDENING W SEW ER OIi D16fYi�®�M @ 83.00 /}�} a "" STATE ENCROACHMENT N PERMIT NO. z INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT 5 z o0 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE '1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE RIBED EXISTING DWELLING TO THE PUBLIC S APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAYIPF 19111 OWNER OR NEW HOUSE SEWER OWNERS AG NT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM n CALIFORNIA OR THAT i AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG RESIDE IN, THE OV DESCRI ED SIDENTIAL PROPERTY. ABANDON HOUSE SEWER G SIGNATURE ITTEE BACKFILL SEPTIC TANKS ❑ OF PERM SEEP,PIT(S) ❑ CESSPOOLS ❑ VALID . ROBERT WOOD CK. M.O. SUPERVISING MECHANICAL ENGINEER CASH LIAO 7 9 5 6- DEC 10 1 C) 0 5.0 0 M q