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Home My Public Portal About5312 ROSEMEAD BLVD_Sewer__ 8&E-4663 f2•S4 A ■ LiCATI®91;. FOR PE \` IT : DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Deportment of County Engineer County of Las Angeles ADDRESS S � Al ADDRESS WM.J. FOX. COUNTY ENGINEER CASSATT D. GRIFFIN.SUPT OF BUILDING LOCALITY "'-'"`r •'-'- FOR APPLICANT JOLL41j, NEAREST CROSS ST. V /J LEGAL r ._ DESCRIPTION LOT NO. 5 OWNER BLOCK TRACT �Q MAIL / � Al, >,._.> .` &may f= ADDRESS �.� {�� _{�fJi 4�� Z-'�-tJ / `CJ SIZE OF LOT ^ NOWOONBLOTS� � -'¢• CITY,0'z!$=- -�-`TEL. N0. I� �,7� USE OF ti BUILDINGS DISTRI,CT/NO. GROUP MAP CONTRACTOR ®`-' -t.3Z�. -Uzi-th"-[-c EK PG S S./ .l ADDRESS CONNECTION DATA CITY TEL. NO. STATIO DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO. ❑ COUNTY UPPER LOWER TYPE OF ONNECTION LENGTH FROM NO. I DESCRIPTION OF WORK FEE Y. CURX P.L. M.L. HOUSE SEWER CONNECTING TO - PUBLIC SEWER @ $ 3.50 - HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. - J NO. WORK TO HOUSE SEWER 1.00 _ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 .PERMIT NO. SEPTIC TANK,SEEPAGE PIT OR _,.PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL WASTE APPROVAL CESSPOOL-DRYWELL SPECIAL CONDITIONS ONLY 2.00 _ CHARGES CONNECTI . CHARGE FEE OVVNERIS PERMIT S i 00 AUTHORIZATION TOTAL FEE — RE413SEMENT FEE IHAVECON- TRACTORT HIS TO CONNE TDATEO THE ABOVEWITH DESCR BED EXISTINGTHE HEREINAMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER ? - NEW HOUSE SEWER ' SIGNED THIS DAY OF2f�L� ]9 OWNER OR CONNECT ADDITIONAL OWNERS 'AGENT � -BUILDING OR WORK / SEPTIC TANK, SEEP, PIT(S) ` ADDRESS U2'�'jp -ALA AND/OR DRAINFIELD 'I 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER. CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ y � .y SEEP.PIT(S) ❑ CESSPOOLS❑ SIGNATUREOF PERMITTEE WILLIAM J. FOX. COUNTY ENGINEER VALIDATION �� X18 4 3:® 0 , .IIs By BY DEPUTY DEPUTY BY BY n .Q DEPUTY- ®�� i DEPUTY 76A64ZD .� � R_ LICAT�ON FOR PERMIT S&E•663 11.55° DIVISION OF BUILDING AND SAFETY SEWED-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles JBUILDING JOHN A. LAMBIE, COUNTY ENGINEERDDRESSCASSATT D. GRIFFIN, SUPT OF BUILDINGOCALITY 44✓bd"NEAREST OR PP NT TO FILL I CROSS ST. LEGAL DESC ALTI N LOT N ® OWNER MAIL BLOCK TRACT -/3 ADDRESS NO. OF BLDGS. CITY TEL. NO. ` SIZE OF LOT NOW ON LOT USE OF . . BUILDINGS j DISTRICT N0. GROUP MAP BK PGj CONTRACTOR a ADDRESS �� CONNECTION DATA d _� STATION ' DEPTH CITY j' /' L. N7-2-671170 _a MANHOLE REFERENCE j ❑ STATE OWER REGISTRATION NO. fa-tOUNTY No. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TOY. CURB (P L. J M.L. TO P.L. PUBLIC SEWER @ $41-1 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @. $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0. EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 •` CO. IMP. N0, 10 45� JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO.'' - ROAD PERMIT-NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. - u ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $I.00 c WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT $ 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON- s APPROVALS DATE INSPECTOR'SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC E __ NEW HOUSE SEWER -_` .' '�•y) J SIGNED THIS DAY OF �� t~ 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK Y% OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND .STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM 1, HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER d CALIFORNIA OR THAT I AM THE LEGAL OW ERF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. SEEPFP[T(SSE P❑CCTEASSNPKOS* L 5 SIGNATURE: ,/ OF PERMITTEE / /rte, ( r -} v� JOHN A. LAMBIE, COUNT4 ENGINEER ALIDATION^ ROBERT A.WOOD, CHIEF PLBG. INSPECTOR. CK. Ea. 0, CASH VV LU 5 7 1 9 u t r l; 2 7 1 u A 5,0 0 P; 76A 64i'b—CE898—10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEARE FOR APPLICANT TO�� FILL^�IN �% �1 p LEGAL . L�7(.�. JL�r j� i i ` DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF SLOGS. G SIZE OF LOT NOW ON LOT �- CITY T.L. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PR CESSED dY PS I BK CONTRACTOR ADDRESS (3 e CONNECTION DATA ^7 .rO D STATION�f/ DEPTH ,/� 43a 16 TEL. NO. �r a 5 ATE LIC UPPER LICENSE NO.. GLASS ^-� MANHOLE REFERENCE H 4 7C [�` T WE NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB p: M.L.TO P.L. PUBLIC SEWER C $7.00 P.G.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO d PRIVATE DISPOSAL SYSTEM @ $3.00 TRUNK PERMIT NO. ROAD PERMIT NO. O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 'EAS[M ENT R wAw ECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD LY EXTN.,CESSPOOL.DRYWELL. @ $5.00 WIDENING 0 OR ST . . O ALTER,REPAIR OR ABANDON HOUSE HWY SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT W NHOLE (� $7.00 PERMIT NO. p. INDUSTRIAL N WASTE APPROVAL CHARGES OWNER'S PERMIT $ 3 00 ON C AUTHORIZATION TOTAL FEE CONNECTIHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. ,r. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS AY OF / �"y r 71 OWNER OR L NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL I BUILDING OR WORK ADDRESS-5731, v SEPTIC TANK,SEEP.PIT(5) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HERE CE T THAT I AM PROPERL REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENS A REQUIRED BY LOS ANGL S OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIF OR �AT I M T LEGAL OW ER OF, AND INTEND TO DISCONNECT PLUG AND R E ABOVE DE BED R ID NT L R PERT:. ABANDON HOUSE SEWER GNAT R % ❑ OF P MrrTEE ACFILL SEPTIC TANKS EEP PIT(S) ❑ POOLS Ell I VALIDA ' 'CK. M.O. CASH L Lo 9 2 4 4 2 OCT 1 0 D 6.0 0-