The URL can be used to link to this page

Home My Public Portal About5410 ROSEMEAD BLVD_Sewer__ -C6E606.,°_63 - T6A642D A'PPUcATION FOR PERMIT - • - ' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL ✓ " • DEPARTMENT OF COUNTY'"ENGINEER BUILDING AND SAFETY DIVISION 4BUILDING JOHN A. LAMBIE, County Engineer ADOREss WILLIAM A.JENSEN,'Supt.of Building LOCA L;TY NEAREST FOR APPLICANT TO'FILL IN CROSS ST. ;9 LEGAL - DESCRIPTION LOT O. OWNER MAIL 'BLOCK TRACT NO. OF BLDGS. - SIZE OF LOT�'C? � NOW ON LOT CITY TEL. NO. USE OF - - BUILDINGS - n n DISTRICT NO. GROUP MAP PROCESSED BY BK .- PG CONTRACT.50 ADDRESS - L CONNECTION DATA CISTATION J� DEPTH TY" EL.. NO. STATE MANHOLE.REFERENCE V'1 REGISTRATION NO.' y _. COUNTY �" G LOWER NO. DESCRIPTION OF WORK .FEE - •TYPE OF CONNECTION LENGTH ROM /� HOUSE SEW ER'CONNECTING TO - Y. CURB P.L. M.L.TO .L. - �(;1 r } PUBLICSEWER@ '$5.00 - - 13- P.C. P.C.'NO. SEPTIC TAN.K,.SEEPAGE PIT.OR CO.IMP. NO. ��7 7 JOB NO. - - O PITS AND OR DRAINFIELD -@ $10.00 'HOUSE SEWER CONNECTING TO - TRUNK PERMIT NO: -ROAD PERMIT NO.. PRIVATE DISPOSAL;SYSTEM @ $3.00- - ^ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INS TR.NO. DATE 0 WORK TO HOUSE'SEWER @ $3.00 • - V OVERFLOW SEEPAGE PIT,'DRAINFIELD - LLI EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 r7 d ALTER.REPAIR OR ABANDON HOUSE - HWY.,ORST.WIDENING t�' �C �� A,� ' SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT C C. c--•C L PERMIT NO. _ - INDUSTRIAL - - _ WASTE APPROVAL CHARGES T�OWDNTER'S - PERMIT t ' '2 oo- - - AUTHORIZATION 'TOTAL FEE, CONNECTION CHARGE FEE - - - "I HAVE AT THIS.DATE CONTRACT W.ITHyT E HEREIN NAMED CON- REIMBURSEMENTFEE TRACTOR TO CONNECT' E ABOVE DESCRI D EXISTING DWELLING - TO THE PUBLIC'S E APPROVALS DATE INSPECTOR'S SIGNATUREa `SIGNED THIS- OWNER OR- NEW HOUSE SEWER "OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SND ANA.SEEP.PITS) 0, HERE BYE ACKNOWLEDGE THAT I "HAVE,READ THIS APPLICAT,ION� AND/OR 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 C3I' HEREBY CERTIFY THAT I AM PROPERLY'REGISTERED AND/OR -ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED LOS ANGLES COUNTY AND STATE..OF SEWAGE DISPOSAL SYSTEM . CA'LIFORNIA OR-THAT THE EGAL OWNER OF,.A D INTEND TO -DISCONNECT PLUG AND, RESIDE IN, THE ABO DESCRI D REIDENT.I ALP PERT Y. ABANDON HOUSE SEWER - SIGNATURE CrN BACKFILL SEPTIC TANKS ElOF+`PERMITTESEEP•PITS) ❑, CESSPOOLS ❑ ' VALIDATION ROBERT ,A. WOOD SUPERVISING MECHANICAL ENGINEER._. CK. M.O.. CASH , 'w.0' 5 9'Z JUL42 9 1 O D' 7.0'0,, 75A642D APPLICATION FOR PER IT 6A64 - -COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY-ENGINEER BUILDING AND SAFETY DIVISION 'BUILDING JOHN-A. LAMBIE, County Engineer ADDRESS 5410 NO. Rosemead WILLIAM A. JENSEN. Supt of Building r� City, LOCALITY yemple . NEAREST FOR APPLICANT.TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER' Green Brothers- MAIL BLOCK TRACT ADDRESS 543" We S•t" Woodbur NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY ta(j TEL. NO. qV USE OF, DISTRICT'N O. GROUP MAP PROCESSED BY BUILDINGS BK PG 45> .l l CONTRACTOR San Marino. PlumbingService �. ADDRESS 1465 San Marino avenue - CON ECTION DATA - STATION DEPTH CITY San Marino 7TEQL. pNO.SJT7 6--71177'7 f� REGISTRATION.N O. /(J6(J1 El COUNTY MANN OLE REFERE5 STATE NCE LOWER NO. I DESCRIPTION OF WORK FEE_ TYPE OF CONNECTION ✓ LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. O PUBLIC SEWER @ $5.00 - SEPTIC TANK,SEEPAGE PIT OR - - P.C.NO. PITS AND/OR DRAINFIELD @ S10.00 im CO.IMP. NO. JOB NO. HOUE SE SEWER CONNECTING TO TRUNK PIT RMIT NO. ROAD PERMIT NO. O PRIVATE DISPOSAL SYSTEM @ $3.00 - 0 CONNECT ADDITIONAL,BLDG.OR - AFFIDAVWAIVER EASEMENT- RECORD. I.N STR.NO., DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00Nj. ABANDON HOUSE HWY.OR ST.WIDENING Zz 1 SEWER AMOMLSMOOM SYSTEM @ $3.00 3 OO STATE ENCROACHMENT PERMIT NO. INDUSTRIAL ' WASTE APPROVAL - CHARGES OWNERS PERMIT $ 21 00 AUTHORIZATION TOTAL FEE 5 OO CONNECTION CHARGE FEE I HAVE AT THIS DATE-A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR • - NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL ' BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) - 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 HEREBY CERTIFY. THAT I AM PROPERLY EGISTERED AND/OR ALTER,REPAIR.SEWER OR _ LICENSED AS REQUIRES BY LOS LES CO TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT i,,!CM TH EG OWr',1 OF, 'FJD T ND TO - If DISCONNECT PLUG.AND RESIDE IN, THE A'B �E C} C IBED' ES D£ TIAL .R0 RT ABANDON HOUSE SEWER SIGNATURE / BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ DATIO ROBERT A. WOOD CK. M.O. SUPERVISING� MECHANICAL ENGINEER CASH . 1,0 3 3 3 3 GDEC 10 1 0 0 5. Q N gpyy ■q qpm PERMIT p(�pp�9��y 1 '�6&E-663 12.54 DIVISION OF BUILDING AND.SAFETY SEWER-SEWAGE DISPOSAL . Department of County Engineer WM. J. FOX, COUNTY ENGINEER ADDRESS County 'of Los Angeles BUILDING S el CASSATTZ. GRIFFIN,SUPT OF BUILDING �� LOCALITY � ��`.�(. C!errz.A . . FOR•APPLICANT. TO. FILL IN CROSS ST. LEGAL DESCRIPTION •-LOT NO. OWNER . BLOCK. TRACT ,/ ` AMAIL DDRESS - .�0NO / SIZE OF LOT yJ 3C. G T V NOWOONBLOTS. CITY TEL. NO., _USE OF mmumm BUILDINGS r - DISTRICT NO. GROUPMAP - - BK PG - CONTRACTOR m7 4 _ , -, -.CONNECTION DATA r IT•4, TEL. NO.s 77de, —&, STATION / f J 57 DEPTH _ s �7ySTATE - MANHOLE REFERENCE l n REGISTRATI N0. � '.� ALJ `COUNTY _ ' UPPER !'-/LOWER TYPE OF CONNECT LENGTH FROM NO. I DESCRIPTION OF WORK FEE Y. CURB P. M.L.TO P.L. / SJ HOUSE SEWER CONNECTING TO PUBLIC SEWER - Q, $. 3.50 HOUSE SEWER CONNECTING TO - _ PRIVATE DISPOSAL SYSTEM 1.00 _ - CONNECT ADDITIONAL BLDG. OR CO. IMP, NO. �! .� JOB. NO.. WORK SEWER 1.00 a� -ALTER OR REPAIR EXISTING .SEWER OR DISPOSALSYSTEM1.00 TRUNK PERMIT NO, ROAD PERMIT N0. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT •AND/OR DISPOSAL SYSTEM 1.00 PERMIT N0. SEPTIC TANK,SEEPAGE PIT OR. - - _ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL-DRYWELL - -" WASTE APPROVAL -/ �ll�=•i-././.�(J.i� /T SPECIAL CONDITIONS CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE / 6 'S._ PERMIT S 11 00 - - AUTHORIZATION TOTAL FEE REIMBURSEMENTFEE TRACTORHAVE TO CONNECTHIS.DATE ONTRTHEA ABOVE DESCRIBED EXCTED WITH THE ISTINGA DWELLING - APPROVALS'" DATE INISPEC70R'S SIGNATURE . TO THE PUBLIC SEW r NEW HOUSESEWER (� SIGNED THIS� ;—T DAY OF��_'l I-`'I Ftp t'p S a' ey t�lA _ -- 'OWHER OR "' ,CONNECT ADDITIONAL -OdWKERS ^A'@•ENT•� ` BUILDING OR WORK ADDRESS- 1 DDRESS W 'AND/ORTDRAIANK'NFEELDPSEP, IT(S,) 1 HEREBY ACKNOWLEDGE THATA HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND'AGREE TO.COMPLY - ` I - _ - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS: _ SEWAGE DISPOSAL SYSTEM . I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR D DISCONNECT PLUG AN LICENSED AS REQUIRED BY.LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER - CALIFORNIA OR THAT I AM THE GAL OWNER OF THE ABOVE - DESCRIBED RESIDENTIAL PROPERTY.",') BACKFILL SEPTIC TANKS❑ .SEEP -PIT(S) ❑ CESSPOOLS❑ " SIGNATURE OF,.PERMITTEF WILLIAM-J. F QX _COUNTY$NGIIEER VALIDATION In 1 • 1 .SEP'�)j . . .�i' 4.50 DEPUTY - - _ DEPUTY - BY BY ';® ./ DEPUTY DEPUTY