HomeMy Public PortalAbout5518 ROSEMEAD BLVD_Sewer__ 8A9 ealiee APPLICATION FOR PERMIT 1
DMBION OF Bump= AND sum SEWER-SEWAGE DISPOSAL
DWmbnent of County EngWm
County of Lw Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS SSI
ES
CASSATT D GRIFFIN SUP T OP BUILDING LouunEST
FOR LICANT TO FILL IN CC8RS9S ST
/ IORNERDESCRIPTION LOT NO SOMAILBLOCK TRACT ADDBESS
BDGCRY TEL NO
SIZE OF LOT y jr6 NOW ON LOT
USE OFDISTRICT NO I GROUP BK MAP
BUILDING! I`
PG
CONTRACTORI _V L41,123
CONNECTION DATA
ADDRESS
STATION Z O / DEPTH
CITY c TEL
NO MANHOLE REFERENCE UPPER
LONER
REGISTRATION NO CJ ��d L— ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER S 3 SO Y CURB P L Al L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3 00
OVERFLOW SEEPAGE PIT GRAINFIELD P C NO
EKTN CESSPOOL DRYWELL MANHOLE $2 00 CO IMP MO SOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CON NE CT ADDITIONAL BLDG OR !TATE ENCROACHMENT
WORK TO HOUSE SEWER ® f 1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® S 1 DO WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEHMM s 1 00
AIITHOHIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS GATE INSPECTOR!SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK I $L
OWNERS AGENT SEPTIC TANK,SEEP PIT(S)
ADDRESS AND/OR GRAINFIELD
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND !TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW! REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS RE ED Y LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA 0 HAT 1 AM THE LEGAL OWNS E ABOVE ABANDON HOUSE SEWER
DESCRIBED R DENTIAL ROPE�n BACKFILL SEPTIC TANKS❑
SIGNATURE OF OF SEEP IT
CESSPOOLS❑
PERMI EE
JOHN A LAMBIE COUNTY ENGINEER VAL[DATION ROBERT A WOOD CHIEF PLBG INSPECTOR
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PERMI
a„`~BD IMMON OF BUMDMG AND APPLICATION O N FO W SEWER—SEWAGE DISPOSAL 1
Dspwbnmt Of E=
Enp1a3M2
County Of E AnQdRB BUILDING
JOHN A tAMBIE COUNTY ENGINKER ADDRESS
M CASSATTD GRIFFIN SUPTOPBUILDING LOCALITY
A APPLICANT TO/'FML IN °E""oU T
LEGALDESCRIPTION AT V (�(J 2 O OWNER
MAIL
BLOCK TRACT ADDRFAB
NO O LOGS CITY TEL NO
312E OF LOT NOW ON LOT
UaE OF
BUILDINGS DISTRICT GROUP �K YAP PG
CONTRACTOR
ADDRESS ,J CONNEMON DATA
CITY TEL NO G STATION DEPTH
lJ MANHOLE RHFEREIIC UPPER
R[ STATE LOWER
REGISTRATION NO ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER 0 f 2 SO Y CURB P L Y L TOP L
SEPTIC TANK SEEPAGE PIT OR
FITS ANO/OR DRAINFIELD 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD CO IMP NO I/
EXTH CESSPOOL ORYWELL MANHOLE R $200 JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 6 $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLOC OR IREGULATIr
TATE ENCROACHMENT
WORK TO HOUSE SEWER a SSWPERMIT NO
ALTER REPAIR OR ABANDON HOUSEINDUSTRIAL
SEWER OR DISPOSAL SYSTEM 100WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEHMPP s00
AUTHORIZATION TOTAL PEEREIr3u°SEYENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HER CON APPROVALS DATE INSP CTOR 33IGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EKISTINLING
TO THE PUBLIC SEWER NEW HOUSE SEWER Irj r
SIGNED THIS DAY OF coxn3cr ADDITIONAL
OWNER OR O •J BUILDING OR WORK
OWNERS AGENT ^ SEPTIC TANK,SEEP PIT(S)
ADDRESS AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS TION CESSPOOL❑ DRYW ELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREEPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS TING ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHERESYCERTIFY THAT 1 AY PROPERLY REGISTE /OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN01 ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF OVE
DESCRIBED RESIDENTS"PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS❑
OF PERM[
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
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