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Home My Public Portal About5450 ROSEMEAD BLVD_Sewer__ TSA 8026 — CEe08 9/73 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 5450 jj•City 1$ CI ADDRESS p80ID88 Temple 1S le Ci yUy PA4 OR APPLICANT TO FILL IN C�ST IR1pN LOT NO OWNER U.S.A. �rolem O MAIL [ [, TRACY p ADDRESS ,,263 - 26th 'tenet NO Or [LOT / Senta Monica TEL NO 333-4772 r LOT Now off LOT clrr F INGS DISTRICT NO GROUP MAP PRO ESSED ST �' � ,I BE P9 ACTOR yWQn B•V8• P1Um �VB �� E ` N. BBQ. AYE• /�CONNECT[ON DATA O e T[L NO �y� STATION /LJf D[rTX 231 741 LIC CLASSC36-20 MANHOLE REFERRENCE / OrrR[[ NO R DESCRIPTION EC WORK I[[ TYP[ORCONN[CT1L[NGTX L UBLI [EWER CONN[CTIMO TO 0 Y CURR rL YL TOPEUCLIC[[W[R O 00 rCtITSA O/ R [RAINFI D MCO IMP NO JOS NO PITH AND/OR ORAINII[LD Y (1000OU[t t[WtR CONN[CTINO TOTRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM 0 t900 ONNECT ADDITIONAL SLDO OR AFFIDAVIT r4W[ [y[R[R[ RECORD INSTR NO DAWORK TO NOUS[S[W[R 0 tfO0VERFLOW SEEPAGE PIT GRAINFIELDSTN CRSSPOOL DRYWELL 0 t6OOLTER REPAIR OR ABANDO OU XWY ORBY WIDENING EWER OR DISPOSAL SYSTEM 0 53M STATE ENCROACHMENT MANHOLE 0 $T 00 PERMIT NO W INMOTR1AL G. WAS APPROVAL [Z� OWNERrS FERMT s CHARGE - AUMOFMTION TOTAL FEE CONNECTION CHARGE F[[ I NAV[ ATTHISDAT[ A C REIMBURSEMENT F[[ ONTIIAR WITH TM[ HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIS[O EXISTING DWELLING TO TME PUBLIC SEWER APPROVALS DAT[ INSPECTOR SIGNATURE SIGNED THIS DAV OF 19_ OWNER OR NEW NOUS[SEWER OWNER[AO[MT CONNECT ADDITIONAL AGGRESS BUILDI NO OR WORK SEPTIC TANK SELF PITISI I N[RCBY THAT THE DGEABO THAT 1 HAVE READ THIS APPLICATION COMPLY AND/OR ORAINiILLD AND STATE THAT TN[ ABOVE It CONNECT AND AWS E LATILY WITH ALL COUNTY ORDINANCE AND STAT[ LAWS REGULATING ❑ PLUYSIN6 AND SEWERS CESSPOOL ❑ DRYW[LL 1 HEREBY CERTIFY THAT 1 AM PROPERLY R[OI[T[R[D AND/OR ALTER REPAIR SEWEROR LICENSED AS R[OUIR[O BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR T 1 AM THE LEGAL OWNER OF AND INTEND TO OISCONN[CT PLUG AND RESIDE IN THE VC PIED R ENTIAL PROP[NTY ASANDONCHOLER B[W[R t10NATUR[ OI PLfYRT[[ BACKFILL SEPTIC TANKS ❑ SL[P PIT ISI ❑ C[SSFOOLS _, VALIDATION CK M O CASH WORKERS COMFT�.NS/_illrl1't6'Fi I. 'OLICY HOLDERZ � 1. 3.jTM 14 8 0 1 8.0 0 'OLICY NUMBER: ]pAp<zo-CHpOSA /]6 APPLICATIONFOR PIfRMIT SEWER—SEWAGE DISPOSAL COUNTY OF LOB ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN DISTRICT x�JD GnouP EK MAP Ps Pno {$Eo er BUILDING l �6 ,/�4 A DOR (/ /V CONNECTION DATA LOCwu]r C NEAREST STATION D[RN CPO{p pT MANHOLE REFERENCE O UIK [R OWNER TYPE or COMNECTIOry 'LENOTX IRON MAIL Y CURB PL ML TOPL ADDRESS •C NO zo CI TSL NO CO IMP NO JOB ryO L AL TRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO pp AFIIOAVIT RAl1f! !A!!{!NT RECORD INOTR NO DAT[ BLOCK TR CT /C;?—/ [l NO OF SLOGS SIZE OF LOT HOW ON LOT HWY ON{T WIDENING UBE IFSTATS ENCROACHMENT ...LDINOp $[KNIT NO CONTRACTOR WASTE APP INDUS APRIAL P CHARD" ADORE{{ Q U CONNECTION CHARGE IEE CITY TEL NO {TAT[ lIC REIMBURSEMENT I[[ LOQ LICENpk NO CLA5{ S. NO DESCRIPTION OF WORK FEE AMOVAU DAT[ INSPECTOR SIGNATURE VW HOUSE SEWER CONNECTING TO d PUBLIC SEWER O NEW HOUSE SEWER N PTIC f NK SEEPAGE PIT OR Z PITS AND/OR GRAINFIELD 0 CONNECT ADDITIONAL HOUSE{EWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM 0 SEPTIC TANK SEEP PIT(S) CONNECT ADDITIONAL SLOG OR AND/OR GRAINFIELD WORK TO HOUSE$EWER O OVERFLOW SEEPAGE PIT GRAINFIELD CESSPOOL Cl DRYW[LL ❑ [RTH CESSPOOL ORYWELL MA..OLE 0 ABANDON OU{ ALTER REPAIR SEWER OR SEWER O 0 SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND �f ABANDON MOUSE SEWER / BACKFILL SEPTIC TANKS ❑ SEEP PIT'S) ❑ CESSPOOLS OWNMS I Issuance Fee s IACKNWLEDGE THIS AUMOMATION TOTAL FEE Q AND HEREBY STATE THAT THE ABOVE IDT CORRECT AI HAVESND AD AGREE TOLCOMr Y WITH ALL COUNTY ORDINANCES AND STAT[ LAWS R[OULATINO 1HAV[ AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON PLUMBING AND SEWERS TRACTOR TO CONNECT THE ABOVE DESCRIBED EKISTING DWELLING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR TO THE PUBLIC SEWER LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SIGNED THIS DAY IB_ CALIFORNIA OR THAT 1 THE L! L WNKR OF AND INTEND TO OWNER OR RESIDE IN THE ABOV SCA DENTIA ROP[1TY OWNERS AOCNT SIONATUR[ VALIDATIONAq CK M O CASH 94SnJAN 51U 0 9.00A-,d 71.111aA ]181130 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGSEWER-SEWAGE DISPOSAL INEER BUILDING AND SAFETY D(VISION {BUIL IN O AA Imsm D8 pf a Euildipy LOCALITY NEAR FOR APPLICANT TO FILL. IN CMOSESSTT LEGAL DUCRI/!10 LOT XO OWNER MAIL .LOCK TRACT ADDRESS NO OF eLDGe SIZE OF LOT NOW ON LOT CITY TEL NO U590 US[ 1SUILOIN0• DISTRICT NO UP GROBY CONTCONTRACTOROR 10 ty MAP 'Z PROCQSe / ADDRESS 1 ,,,Q,/�(,(�p.�(,dL(r? , CONNECTION DATA CITY TEL NO 73 L� STATION DEPTH STATE UPPER R[OIfTRAT30M NO D / ❑ COUNTY MANHOLEREFERENCE LOWER NO DESCRIPTION OF WORK IEE TY P[OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TOCURS P L MI. TOPIL PUSLICSEWCR O iB Do SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINPIKLD O [IO OD JOB MO O HOUSE SEWER CONNECTING TOMIT NO ROAD PERMIT NO V PRIVATE DISPOSAL SYBTKM m N GO CONNtCTADD ITIONALSLOO OR [MYO IMISw RECORD INS" NO DAT[ O WORK TO HOUSE BCW[R iSGO OVERFLOW SEEPAGE PIT GRAINFIELD [KTM CUSFOOL ORYWELL MANHOLE O f]GO ALTER REPAIR OR ABANDON HOU{ ORST WIDENING SEWER OR DISPOSAL SYSTEM E]OOOACHMENT ' _ NO OWNMS` PERMIT f 001 CHARGES AUTHORIZATION TOTAL FEEN CHARGE 1E[ 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON R[IMBURSLMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRI.CO [[(.TING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR p SIGNATURE SIGNED THIS DAY OF IG_ OWNER OR NEW HOUSE SEWER OWNERS AO[NT CONNECT ADDITIONAL •UILDING OR WORK ,7 ADDRESS SEPTICTANK SEEP PITIq IK: ACKNOWLEDGE THAT I HAVE READ THIP APPATION AND/OR DRAINFICL AND {TATE THAT THE ABOVE IS CORRECT AND AOR[. D TO CLICOMPLY WITH ALL COUNTY ORD INANC[S AND STAT[ LAWS REGULATING FLUMSI NO AND S[W[RS CESSPOOL ❑ ORYW[LL ❑ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ON ALTER REPAIR SEWER OR LICENSED AS RCOUIR[O .Y LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL EYST[M CALIFORNIA OR THAT 1 AM THE LEGAL OWNER 01 A O TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DUC I. RESIDE IAL R RT ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE SACEF ILL G) IC TANKS S[tP PIT(G) U CESSPOOLS /1VAIMATION ROBERT A WOOD M o CASHSUPERVISING MECHANICAL ENGINEER 4 1 5 0Z2 AUG 15 1 0 D 5.0 0" e 6dtlllr� SS"C� �os� VM e � 2& 88 APPLICATION FOR PER IT ° DIVISION OF BUMDING AND SAFM SEWER—SEWAGE DISPOSAL Dspw mow of Comty EnglnwGt County of Z ABgwlu ADDRESS 1 M� WM J FOX, COUNTY ENGINEER CABBATT D GRIFFIN BUP T OF BUILDING LOCALITY {.*�Al It i±j FOR APPLICANT TO FILL IN NEAREST d ROSE ST LEGAL DESCRIPTION LOT NO I } �-. OWNER 1 C BLOCK TRACT f HAIL ADDRESS NO OF BLDGS SIZE OF LOT C NOW ON LOT If CITY TEL NO USE OF BUI LOING! Z ' DISTRICT NO GROUP YAP .�0I S = - O°MP CONTRACTOR k IC, /V a IODL SIC 5 .Py�J ADDRESS �+ yCONNECTION DATA CITY Nor.Cµ.t TEL NO 6 7 STATION t p I. It DEPTH ^ ['STATE � EY ERENCE REGISTRATION NO UPPER fJ ❑ COUNTY TYPE OF COMNECTI�Y..� LENGTH FROM NO DESCRIPTION OF WORK FEE Y CURB ry L' l M L To P L HOUSE SEWER CONNECTING TO 570 J PUBLIC SEWER ® S 3 SO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR CO IMP NO 7 JOB NO WOR K TO NO. SE SEWER 100 ALTER OR REPAIR EKISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT ' ANb/OR DISPOSAL SYSTEM 100 PERMIT NO SEPTIC TANK,SEEPAGE PIT OR PITS AMD/OR DRAINF15LO 2 00 INDUSTRIAL CESSPOOL-DRYWELL -- WASTE APPROVAL SPECIAL CONDITION!ONLY 2 00 CHARGES CONNECTION CHARGE FEE OWNER'S FEei nT s t 00 AUTHOMATION TOTAL PES !rtjREIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- '*e TRACTOR TO CONNECT THE ABOVE DES RIBEO UISTING DWELLING APPROVALS DATE IRS ECTOR S SIGNATURE TO THE PUBLIC 3 SIGNED THI DAY F L 19ZJ NEW HOUSE SEWER Z S i OWNER OR CONNECT ADDITIONAL OWNERS A BUILDING OR WORK ADDRESS ANO/IORTDIAANKIIFIELSEEPDPIT(8) -- I HEREBY ACKlr0WL G THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELLC AND !TATE THAT THE YE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY "VIRCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONABANDON NO UPLUG AND CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVEBE SEWER DESCRIBED RESIDENTIAL PROPERTY CKFfL � 4R a f D t ted O,r• CA - S* Jv SBEAEP PITLSSE C CESSPOTANKSOL6 SIGNATURE OF PEp YITTEE WtL.UAM J FOX,COUNTY ENGINi1ULia VALIDATION BYAC t-2. 5"7r " l a 450 DEPUTY DEP BY BY ® DEPUTY DEPUTY CEaoa D -0R 10a 70A84 APPLICATION FOPERM COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPAHTG�NT OF COUNTY ENGDiEER BUDDING AND SAFETY DIVISION BUILDING WMALAMBIE CGQRty EBHG BBT ADDRESS WRCIAM A RMSEN SUP t of BvIIA nq LOGLITY NGREBT FOR APPLICANT TO FILL IN cRoaB er [CONTRACTOR CRIRION LOT NO OWNER MAIL CK TRACT ADDRESS NO OF SLOGS E OF LOT NOW ON LOT CITY TEL NO Or LDINGS DISTRICT N GROUP MAP RROCCSS BY SK P`_O/ � o — �T ADDRESS 0:9 zoo CONNECTION DATA jt�7MANHOLZ Ar1oN '� DertH CITY TEL NO7;1 UPPER REGISTRATION NO O REFHRENCENO DESCRIPTION OF WORK Fa[ TYPE Or CO Ion LE r[OM /HOUSE SEWER CONNECTING TO UR M L TO P LPUBLICSEWER 0 )S OOG.SEPTIC TANK 6f6PAOi Pl OR JO NO O P1,3 ITS AND/OR ORA INFI CLD 4 )1000 IMP MO JOS NO V HOUSECW[RCONNECTING TO UNK PERMIT NO ROAD PERMIT / 0[ PRIVATE DISPOSAL SYSTEM O 5300 O CONNECT ADD ITIONAL SLOG OR AFFIDAVIT RY1.. ....Y[Yf RECORD INSTR NO DATE 0 WORK TO HOUSE SEWER 1300 OVERFLOW SEEPAGE PIT GRAINFIELD EXTN CtSBPOOL ORYWELL MANHOLE O )S OO d ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING y SEWER OR DISPOSAL SYSTEM 49 31300 STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL WASTE APPROVAL OWM1 OWNER'S PEH7 $ z 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HG[IH NAMED CON REIMBURSEMENT FEE TRACTOR TO IS CONNECT THE ABOVE DESCRIBED EZTINO LI DWELNG APPROVALS TO THE PUBLIC SEWER DATE INSP OR S SIGNATURE SIGNED TH19 DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGE NT CONNECT ADDITIONAL ADDRES6 BUILDING ORRWORK WORK BCPTICTANK SCEP PIT(S) I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATS LAWS REGULATING PLUMBING AND aEWE RE CESSPOOL Cl DRYW[LL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE Or SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER Or AND INTEND TO DIBCONN6CT PLUG RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUS U"AND AND SIGNATURE ❑ WER OF P[RMI TT[[ BACKFILL SEPTIC TANKS S[tP PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M o cweH SUPERVISING MECHANICAL ENGINEER LA(IO1 1 2 3�8 APR 11 1 o D 7..°00- G� lio