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HomeMy Public PortalAbout5406 ROSEMEAD BLVD_Sewer__ DEPARTMENT OF COUNTY ENGINEER � SEWER—SEWAGE E DIS' POSAL- '@ DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1 COUNTY OF LOS ANGELES WILLIAM J. FOX, CGLINTY ENGINEER BUILDING :54 I ADDRESS J d©IO LOCALITY BUILDING FOR APPLICANT TO F14L IN j�`nr�/w Ct NEAREST ADDRESS .�y CROSS ST. A4104�U IOUCtl LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. "c NEAREST A ��� ! 3l Gg a CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED.. OWNER V, //V MAIL /y/_ USE ZONE OCCUPANCY MAP ADDRESS 11ss(� J I BK PG a 1 l CITY TEL.NO. (��. .1 � < `-- J[E _ CONTRALTO "�jv CO.IMP.NO. i 7 _Z C ADDRESS 9 JOB.N0. wCITY TEL.NO. /(/'�y TRUNK PERMIT NO. STATE REGISTRATION NO. COUNTYi ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0. PERMIT NO. BLOCK G TRACT �, J INDUSTRIAL DO WASTE APPROVAL Ry,too, DATEx�L -, 3 SIZE OF LOT %� KNOW ON LOTS. CHARGES USE BUILD_If GS- I CONNECTION CHARGE FEE NO DESCRIPTION OF WORK FEE REIMBURSEMENTFEE_�_ MOUSE SEWER<CO,NNECTING TO r "^ >� PUBLIC SEWER @V; 3:50 5 U RECEIPT'NO. DATE (BY -HOUSE SEWER,CONNECTING TO PRIVATE DISPOSAL SYSTEM` 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00' N0. DATE BY ALTER OR REPAIR EXISTING SEWER OR DISPOSALSYSTEM 1.00 DISCONNECT AND ABANDON SEWER". AND/OR DISPOSAL SYSTEM -- 1.00 I CONNECTION DATA • SEPTIC TANK,SEEPAGE IT OR ' PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH (' CESSPOOL—D RYW ELL G p SPECIAL CONDITIONS ONLY 2.00 I �a 1 .) MANHOLE.REFERENCE UPPER. LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT ; I I 00 • Y — CURB P.L. M.L.TO P.L. 4//Uw AUTHORIZATION " TOTAL;FEE q 57) :. I .1 I 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 rZ SIGNED THIS.---;-- .--_ AY OF........... w _-------------- CONNECT ( NEW HOUSE SEWER OWNER-. OR".-' CONNECT ADDITIONAL ,OWNERS AGENT..- BUILDING ESS ADDR P AND/OR DRAINFIELD IT(S) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-, CESSPOOL DRYWELL CATION AND.STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT,H�ALL COUNTY ORDINANCES-AND STATE LAWSI 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 JOESI DENTIAL PROPERTY. BACKFILL SEPTIC TANKS(] yi SEEP.PIT(S)E] CESSPOOLS El SIGNATURE //�,I'/ OF PERM ITTEE° - s.�! .-..- -..............•...........:, 76A642D-663 1/53 .I