HomeMy Public PortalAbout4942 ROSEMEAD BLVD_Sewer__ 'FOR PERMIT
APPLICATION"
DIMON OF BUILDING AND SAFM SEWER-SIEWAGE DISPOSAL
Depmtnaag of Comatr Fmsbw*r
00� Of lAw Anaelos BUILDING
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U
wm-J. Fo)(4 C4)UKTY knommut BUILDING
Lo 71—)�
CAI"TT D.OPUMN, WtYPT Olt RUTLDIN18 LOCALITY
NEAREST
FOR APMCAM TO M IN —CROff STi.— aj�al, 10Z w
LEGAL
DESCRIPTION ,LOT NO.
OWNER
a-tAA MAIL
BLOCK TRACT ADDRESS
1110. Or 13I.M. 'TEL-no.
SIZE by LOT NaW ON LOT CITY DISTRICT No. !] ---
USE OF GROUP MAP
BUILJ)iNQ$ ox P9
CO"CT011 0 4b
ADDRESS CONIM=ON DATA —Z
N,
CITY q� 'lAt TFL N0. STATIODEPTH F A , -
El STATE MANHOLE11\E'FERENCE UPPER
REGISTRATION NO. 0 COUNTY /lo LOWER
No. DESCRIPTION OF WORK FEE
*pF OF CO "TH FROM
-HOUSE SEWER CONNECTING TO Y. CURB ECTIOV.L To R.L.
PUBLIC 5ir*ER 5.56
HOUSE SEWER CONNECT'RQTO
PRIVATE DISPOSAL SYSTEM 1.00 P. C. N 0.
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER. — 1.00 CO. 1MP. N0. JOB No.
ALTER OR REPAIR EXISTING TRUNK PERMIT NO, ROAD PERMIT NO_-
SEWER OR DISP03AL SYSTEM 1.00
DISCONNECT AND A DON BEWFR STATE ENCROACHT
--AND/OR DISPOSAL MUNN 1.00 — PERMIT NO. �
S%7IC TANK,SEEPAGE PIT OR 1-110 . (21 WASTE. AP VAL
PITS AND/Olt DFLAIMFIELD :Woo 125 INDUSTRIAL,
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY' • 1.00 — CHARGES
cox4CTInu rij&*rE FEE
OvnOWS 1 00
�WTHOBIZATION TOTAL FM I ac-J REJ"jJRSEMENT FEE
I HAVE THIS DATE! CONTRACTED WITH THE HEXgEItKjNNAgp CON- 'S SIGNATURK
E 13 r DATE ImSPRCT(*l
TRACTOR TO CON14ECT THE ABOVE DESC IBID DWELLING AMOVALS
TO THE PUBLIC SEW$R NEW HOUSE SEWER
SIGNED THIS SAY OF 19—
CONNECT
OWNER OR BUILDING OR WORKADDITIONAL
OWNERS AGENT — SEPTIC TANK,SEEr.PIT(S)
ADDRESS AND OR DRAT LD A
I HEREBY ACKNOWLEDGE TI AT I HAVE READ THIS APPLICATION CESSPOOL d DRYWELL[I
THAT THE ABOVE IS CORRECT AND AQRjrK TO COMPLY
-A%STA-rE
ALL COUNTY
ORDINANCES AMD STATE LAWS REGULATING ALTER,REPAIR i 5 EWER 0 R
51WDISPO AL SYSTEM
PLUMBING AND KRS. SEWAGE
I HE�iEBY CERTIFY THAT I AM PROPERLY REGISTERED AND/O
UCgNSjjD AS REQUIRED BY LOS ANGELES COUNTY AND STATE 0; FC PLU,AMD
4EWE,
')IS
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE A191"N HOUSE
Dr,$CltiBMD RESIDENTIAL PROPERTY, BACXFILL,8E:P3C TANXiZ LJ
SKE0.PIT 8) CM,
SIGNAT"s
or PER III I
WILLIAM J.FOX.COUNTY 990IMMM VALIDATION M A.WOOD,CH"y rLw. INAPI
CTOk
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