HomeMy Public PortalAbout5136 ROSEMEAD BLVD_Sewer__ 111PPLICATION FOR PERMIT
claeos•a-sa COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS
S-� ,pO S P a
JOHN A. LAMBIE, County Engineer ADDRESS �f
CASSATT D. GRIFFIN, Supt of Building LOCALITY t C, Z
.. .. ......... - NEAREST
FOR'!
TO FILL IN CROSS ST. ,�. f✓•
LEGAL OWNER d►q [ /
DESCRIPTION LOT N0.
BLOCK TRACT / MAIL
ADDRESS
�SIZE OF LOT �•OF BLDGS.
7 �S NOW ON LOT I CITY TEL.NO.
USE OF
BUILDINGS DISTRICT N0. GROUP MAP PROCESSED BY
CONTRACTOR /
ADDRESS �'�„ (� �', '4 �• 4(�ONNECTIONA-gyp
sCITY /Qrl p1."�Ea TEL.N0. .,sL. ��a s ® -' DEPTH
.TATE A HOLE REFERENCE/ U
REGISTRATION NO. i LJ COUNTY 1
NO. DESCRIPTION OF WORK FEE LO E +
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
PETS ANIC D%OR DRAINFIELD T OR @ $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.—P CelC JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.004 92!5
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEWS PERMIT $ 2 00 CONNECTION CHARGE FEE.
y: AUTHORIZATION TOTAL FEE ,0 ^u 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 SEWERr-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
3 I HEREBY ACKNOWLEDGE THAT 1 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 f TER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM HE LEGAL 94NER OF THE ABOVE gACKFIL SEPTIC TANKS[IDESCRIBED RESIDENTIAL P ERTY.
SIGNATURE SEEP. (S) ❑ E POOLS
OF PERMITTE - �/
OF ALIDATION ROBERT A.WOOD
cic. M.o. CASH SUPERVISING MECHANICAL ENGINEER
LjTo 6 0 7 1 Gs;'sY' 8 0 A 5.0 0 .
7 APPLICATION FOR-PERMIT
1-
CE808.8-SB 08.8
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER : „-
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS / Q P o I
CASSATT D. GRIFFIN, Supt of Building LOCALITY
71
NEAREST
FOR APPLICANT T FILL IN CRosS ST:
LEGAL
DESCRIPTION LOT N0. OWNER tT C
BLOCK TRACT MAIL
j 0 �. ADDRESS
OF BLOGS.
SIZE OF LOT OW ON LOT CITY TEL. NO.
USE OF -
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR � � �
ADDRESS CONNECTION DATA
CITY /W�,� TEL. N0. ;, � d �' DEPTH
STATE MANHOLE Ei�EN UPPER
REGISTRATION N0. � ® COUNTY
NO. DESCRIPTION O WORK FEE a ER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $5.00 TYPE OF CO NECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR
Y.
RB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N
WORK TO HOUSE SEWER @ $1.00
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT N0. '
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PEST $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 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 �p CONNECT ADDITIONAL
OWNERS AGENT s" 0� BUILDING OR WORK T
SEPTIC TANK,SEEP,PIS)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
I HEREBY CERTIFY THAT I 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 THE LEGAL R OF THE ABOVE
DESCRIBED RESIDENTIA OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. IT(S) ❑ CESSPOOLS
.
OF PERMITT �J
i V
OF VALIDATION ROBERT A.WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
I_lCo 6 U '7 0� °4 t 8 1 2 a 2 5.0 0 M