HomeMy Public PortalAbout5134 ROSEMEAD BLVD_Sewer__ 9B'A642G-_, APPLICATION FOR PERMIT
ceaos.s-ss'' COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS 0 Q
CASSATT D. GRIFFIN, Sup't of Building LOCALITY o, 4. Ct
NEAREST
FOR APPLICANT TO FILL'IN CROSS ST. l
LEGAL ¢� OWNER C/II
DESCRIPTION LOT N0.
BLOCK TRACT G G MAIL
Y ADDRESS
NO.OF BLDGS. /
SIZE OF LOT NOW ON LOT / CITY TEL.NO.
USE OF m
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
f`i�g J/ � T BK *. PG
-, CONTRACTOR��®gi2 C d a C" .
ADDRESS �,� CONNECTION TA
CITY z,V TEL. N0. STATION DEPTH
(TATE gpN L ERE E C� /.�
' REGISTRATION NO. LJ COUNTY /r 0d QW_ER�
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO o
PUBLIC SEWER @ $9.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM O.
,» PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN„CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C,N0,
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @.$1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
' CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE d 0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. ,
SIGNED THIS DAY OF 19_ NEW,HOUSE SEWER -/3-9rj 91
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT / BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IIHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I M THE LEG,&L OWNER OF THE ABOVE
DESCRIBED ESIDENTIAV
YROPERTY. BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS❑
SIGNATUREAbezle
OF PERMITTEE
i
®v ALMATION ROBERT A.WOOD
cK.
M.o. CASH SUPERVISING MECHANICAL ENGINEER
L Co 5 0 7 4 MA” 81 0 A 5.00
APPLICATION FOR PERMIT
cesos-s-sa COUNTY OF LOS ANGELES .1.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS a vb-c—
JOHN A. LAMBIE, County Engineer �¢.
CASSATT D. GRIFFIN, Supt of Building LOCALITY / \
NEAREST
FOR APPLICANT TO IN CROSS ST. .mayy ,
LEGAL OWNER °7
DESCRIPTION LOT NO.
BLOCK TRACT pAIL
DRESS
NO.OF BLDGS.
SIZE OF LO]g X��. A�S'i NOW ON LOT [ CITY TEL.NO.
USE OF
BUILDINGS DI DISTRICT N0. GROUP M&P PROCESSED BY
l�
BK P6
CONTRACTOR
ADDRESS -Z 2—S �! CONNECTION ATA
CITY a,* TEL. NK DEPTH
/ NATE ANHO FE N E UPPER
6�
REGISTRATION NO. � LI COUNTYAv
0
NO. DESCRIPTION OF RK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1.00
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
O CHARGES
OWPNER•S PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 0 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S).
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
VA AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL
WITH ALL -COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRE&BYL ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT LEGAL NER OF THE ABOVE
DESCRIBED RESIDENTIAY. BACKFILL SEPTIC TANKS❑
SEEP. IT(S) ❑ 'CESSPOOLS
SIGNATURE
OF PERMIT 49
FAM �6
®e VALIDATION ROBERT A. OOD
CK. H.o. CASH SUPERVISING MECHANICAL ENGINEER
�,; 6 0 •7 '3 r rt'y` 8 1 1 A 2 5.0 0
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