HomeMy Public PortalAbout5138 ROSEMEAD BLVD_Sewer__ D
cgeostAPPLICATION F®-F;." E.
P 'RIVI-I`T
Es P='s ss COUNTY.OF LOS ANGELES,
DiPARTMENT OF COUNTY-ENGINEER'
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County,Engineer. '` ADDRESS Q 6 b'
CASSAIT D. GRIFFIN, Sup't of Building . LOCALITY
NEAREST
FOR APPLICANT TOIN CROSS ST. e
ULL
LEGAL
DESCRIPTION LOT N0. �7 OWNER 4,h• :-
BLOCK TRACT /�( /�, s MAIL
b11 ADDRESS
NO.OF
SIZE OF LOT/®OX S NOW ON LOTS,
CITY TEL. N0.
USE OF
BUILDINGS R a DISTRICT NOJ GROUP BK MAP •PGPROCESSED BY
I
CONTRACTOR
ADDRESS Z W CONNECTION " TA
CITY TEL. NO: yffs DEPTH
COSTATE MA HOLE REFEREN ) UP ERS-'
REGISTRATION.NO. JJ ❑ COUNTY 0
NO., DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO —�
PUBLIC SEWER .@ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH.FROM
CURB �--
Y , L.
PITS AND/OR DRAINFIELD @ $3.00 - 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. SCJ Q JOB N0.•,
12
CONNECT ADDITIONAL BLDG.OR, TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM. @ $1.00 PERMIT,NO.
INDUSTRIAL
WASTE APPROVAL,
CHARGES
6wnws PERMIT $ 2` 00 CONNECTIOWCHARGE FEE
AUTHORIZATION TOTAL FEE 0_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 S ',;
OWNER OR'. - CONNECT ADDITIONAL `
OWNERS AGENCA,) 'BUILDING OR WORK'
ADDRESSEPTIC TANK,SEEP,PIT(S) '
S AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I-HAVE. READ,THIS APPLICATION
AND STATE THAT THE ABOVE -IS CORRECT-AND'•.AGREE,TO COMPLY "CESSPOOL EL,DRYWELL❑
WITH ALL COUNTY ORDINANCES AND-STATE`,'LAWS.REGUL.ATING' 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 REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL 0 ER OF' THE ABOVE
DESCRIBED RESIDENTIAL PEf Y. BACKFILL SEPTIC TANKS❑<
SIGNATURE - SEEP. P, S) ❑-'C SSPOOLS
OF PERMITTE '
®r - ALIDATIONROBERT A:WOOD
clt.• -.m.0. CASH SUPERVISING MECHANICAL ENGINEER -
L��-,6�o '69� MIn;< � 1 � A 5.a"0
„
�13 e® a ® ewU. `qy pp����
7878428 - AY Li.�f TI®Y;V FOR _e .E !!�.IT _
CEB
COUNTY OF LOS ANGELES $EWER”SEWAPE _DISP®SA'L
DEPARTMENT OF COUNTY ENGINEER,.
BUILDING-AND SAFETY DIVISIOPI BUILDING, ;
ADDRESS:' o`Sp
JOHN A. I.AMBIE County.Fmgineer x �'
//, .. `!m P
D. GRIFFIN, Supt of Buildiag LOCALITY• " .CSI' le ' c
NEAREST'. :.
FOR .APPLICANT.TO ILL IN. CROSS ST: .::
LEGAL-
DESCRIPTION
EGAL DESCRIPTION I:OT No o DWNER
BLOCK TRACT- Q MAIL
f� . .ADDRESS
NO.OF BLDGS.
- y
SIZE OF LOTfo.® JC`J / NOW ON - CITY ��• TEL.'-NO:
USE OF DI5TRICT.NO. GROVE MAP. ROCESSED,BY 'Y
BUILDINGS :. .�. - _ - -
/� BK •. PG
CONTRACTOR '7 �12 l�/li C� '' / J
�a
.ADDRESS -ate b N CONNECTION•DATA,
CITY TEL.,N0. - Q y./ DEPTH
f E7
z ❑ ,STATE NHOLE_REF EN
REGISTRATION.NO. O COUNTY - UPPER
No. DESCRIPTION OF WORK FEE:.
HOUSE SEWER'CONNECTING TO
PUBLIC•SEWER @ $3.00 c
SEPTIC TANK, SEEPAGE PIT OR TYP.E OF"CONNECTION LENGTH FROM
,PITS AND/OR DRAINF.IELD.' '@ $3.00 -Yl - CURB P.L. M.L.-TO P.L.
SEEPAGE PIT,PIT, DRAINFLELD •' '. ' # -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 - - -
HOUSE SEWER CONNECTING TO ;., CO.IMP..NO:. JOB;NNo.-
PRIVATE
-DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL-BLDG.OR" TRUNK PERMIT NO, ROAD PERMIT N0.
WORK TO HOUSE SEWER @.$1.00
SEWER OR DISPOSAi ABANDON
YSTEM HOUSE ,. @ $1-.00 STATE ENCROACHMENT- r
PERMIT NO."'
INDUSTRIAL- - -
- - WASTE-.APPROVAL
Q CHARGES
OWNERS
PERMIT �: CONNECTION:CHARGE FEE
AUTHORIZATION TOTAL FEE '." REIMBURSEMENT FEE
L.HAVE AT THIS'DATE 'A CONTRACT WITH THE HEREIN NAMED CO - APPROVALS DATE •, INSPECTOR'S SIGNATURE
TRACTOR TO-CONNECT THE ABOVE DESCRIBED EXISTING•.DWELLING
TO THE.PUBLIC SEWER.
SIGNED THIS DAY OF 19- R'•.,
NEW HOUSE.SEWE .. ATT
OWNER OR CONNECT ADDITIONAL
/p _ n /
OWNERS AGENT BUILDING.OR WORK
SEPTIC'TANK,SEEP:PIT(S) �t
ADDRESS I
AND/OR..DRAINFIELD,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ-THIS.APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO-COMPLY CESSPOOL❑ -DRYWELL 0-
WITH
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,'SEWER OR /� G - �i
'PLUMBING AHD' SEWERS. -- - SEWAGE,DISPOSAL SYSTEM
LICENSED AS REQUIRED'B LOS ANGELES.0 REGISTERED AND/OR DISCONNECT PLUG AND -;
I 'HEREBY CERTIFY THAT I AM PROPERLY.
COUNTY AND STAT OVE'OF ABANDON HOUSE SEWER',
CALIFORNIA_ OR,THAT M THE, LEG "OWNER OF '.THE ABOVE
DESCRIBED RESIDE TIA ROPERTY: BACKFILL"SEPTIC'TANKS❑ �/ � 7! t
SIGNATURE SEEP:P S) ❑ CESSPOOLS 0,
is
®P --VALIDATION. -OF-PERMIT FE
ROBERT A OOD
E cK ra o CASK SUPfiRVlSING MECHANICAL.ENGINEER .