HomeMy Public PortalAbout5112 ROSEMEAD BLVD_Sewer__ DEPART 1ENT OF COUNTY ENGLVEER SEWER-SEWAGE DISPOSAL g�
DIVISION OF BUILDING AND SAFETY .�Z/ PERMIT APPLICATION L
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS + 1 :
FOR APPLICANT TO FILL IN LOCALITY
,C#-CZ
BUILDING NEAREST
ADDRESS / k J' CROSS ST.
LOCALITY / DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A'r
CROSS ST. RECEIVED BY Ready for Inspection AT I>S U D
OWNER eh, t. A
MAIL USE ONE OCCUPANCY MAP
ADDRESS ^ j I SK PG
' ty
CITY TELAO. :.3.�- *
CONTRACTOR•4,>,_ ?F CO. r.NO.
A
ADDRESS , 1J+ Aj�1, '�"C<�:. ` JOB.N0.
CITY TRUNK PERMIT N
�/ STATE
REGISTRATION NO./ 7 -- RI-COUNTY ROAD PERMIT NO.
LEGAL ` STATE ENCROACHMENT
DESCRIPTION LOT NO. • �i _ PERMIT NO.'
BLOCK TRACT + �•J S^� - /,2 -� IND 6TRIAL
TEAPPR0VAL
SIZE OF LOT j N0.OF N BLDGS. Z
NOW OLOT �,``T CHARGES
USE
BUILDINGS CONNECTION CHARGE FEE �+
r
NO. DESCRIPTION OF WORK FEE RE11116URSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. DAS_E i BY
HOUSE SEWER CONNECTING TO '' "'
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. DATE 6Y
SEWER OR DISPOSAL SYSTEM I.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM I.00 CONNECTION DATA
f SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION �_.� DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHCtE$EFERENCE
UPPER" LOWER
TYPE OF CONNECTION L TH FROM
Y. CURB P.L. M.L. L.
OWNERS ( PERMIT $ I 1 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER —
SIGNED THIS---------------- .......
_----.-.--DAY OF ---------__-.--.----.-.---.- NEw HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT...........---•---•---------•----•----•------------------------------
SEPTIC TANK,SEEP.PIT(S)
ADDRESS---------------...........-•--.................................-•-•----••--......... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILLSEPTIC TANKS
�
SEEP.PIT(S)E] CESSPOOLS D
SIGNATURE �!f/ j Xtl• �j_f(
O F PER M I TT E E... --------='-----•-----------------•---•---•-•-•-•--•------------
7GAG42A 663 7/53