HomeMy Public PortalAbout5541 ROSEMEAD BLVD_Sewer__ CESGS2/Tp APPLICATION FOR PERMIT
TSA 6420
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE. COUNTY ENGINEER\ .OGRESS
COLEMAN W JENKINS SUPT OR BUILDING LOCALITY
APPLICANTFOR TO FILL IN =REST CL
(PRINT OR TYPE ONLY) CROSS ST / fE/00
LEGAL
DESCRIPTION LOTNO OWNER / j V Lf4 49
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PERMIT NO
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AUTHORMATION TOTAL FEF CONNECTION CHARGE IE[
I HHAEVE AT[1TEH15 DIA•TE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEW
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING AlCI�OVALJ
TO THE PUBLIC SEWER DAT[ IN CTOR• ONATURE
SIGNED THIS DAY OF 1B_
OWNER OR NEW HOUSE SEWER hl
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC]TO
S[PIICTANK BE" PITIS)
AND STAT[ THAT TH9 ASOV[ IS CORRECT AND .ONE[ TO CAND/OR DRAINFIELD
WITH ALL COUNTY ORD( MCU AND STAT[ LAWS REGUL
PLUMBING AND S[W[M CESSPOOL ❑ DRYWCLL ❑
1 HEREBY CERTIFY T AT 1 AM PROPERLY REGISTERED AALTER REPAIR S[W[ROR
LICENSED AS R[OOIR SY LOS ANGLES CO TY AMO STASEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH AM THE LEGAL OWML 01 AND INTERIG AL PROPERTYDISCONNECT PLUG ANO
ABANDON HOUR[S[W ER
SIO,AP[RM / BACKFILL SEPTIC TANKS ❑
S[LP PIT1S) ❑ Ct1SPOOL)
VALIDATION JACK R ALLEN
<! M O CASH SUPERVISING MECHANICAL ENGINEER
16f'„ 9 0 3 79 HAR 9 1 0 D 5.0 0-
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DFTAATRffiVT OF COU74W ENGINEER C SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUUMrNG AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANOELES
WILLIAM J. FOX, CDUN1M[
TY ENorn BUILDING ^�
AGGRESS
FOR APPLI T RLL IN LOCALITY----r—,
BUILDING NEAREST 1
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Ready for Inspection DATEISSUED
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REGISTRATION NO 7 B 7 / 8 COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO TJ/'� s /1VIe rT IV_ STA
ERMIT NOROACHN[MT , le (1
BLOCK TRACT G �� INDUSTRIAL CX
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SIZE OF LOT NO W ON LOOF BLOBS.T 2+ CHARGES
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USE OF
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No DEEiC ION OF WORK F[[
BES NNE REIMBURSEMENT FEE
PUBLIC SEWER B Lso ?i RECEIPT NO BY
HOUSE SEWER CONNECTING
PRIVATE DISPOSAL SYSTEM IN
CONNECT I I N L BLDG O EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
A Lr ER OR R PAIR EXISTI NO DATE BY
SEWER OR DISPOSAL SYSTEM IOo
DISCONNECT AND ABANDON SEWER
ANO OR DISPOSAL SYSTEM 16o CONNECTION DATA
S P 10 TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION 4 9. DEPTH '
SP6ECIAL CONDITIONS ONLY 2001 1 -115.G nI N UP FERENCE
TYPEECTION LENGTH FROM I
I 00 CUR
OWNERS PERMIT = ML TOP L
AUMOREEATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSISHATURE DATE
DWELLING TO THE PUBLIC SEINE
SIGNED THI A OF 19 NEW HOUSE SEWER -l"Or-k le '3- SL
OWNER OR CONNECT ADDITIONAL
OWNERS AGHMT BUILDING OR WORK
SEPTIC TANK.SEEP.PFT(S)
ADDRESG_ ANO ORD NFIELD
I HEREBY ACKNOWL1196E THAT 1 HAVE READ THIS APPLI• CESSPOOL[] DRYW[LL
CATION AND STATE THAT THE AROVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWER& SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER ��''II
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SEEP PfT(S)0 CESSPOISSIGNATURE Me
OF PERMITTEE
76AUU 603 7/62 (�
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A {zD APPLICATION FOR PERMI
Ta
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING J
JOHN A LAMBIE COUNTY ENGINEER ADDRESS C (�
COLEMAN W JENKINS SUPT or BUILDING
LOCALITY
R APPLICANT TO FILL IN ..ARES'
(PRINT OR TYPE ONLY)
CR
ST aF(J f
LEGAL
D[KRIITI°N LOT NO OWNER
PAIL
BLOCK TRACT
ADDU[.{ 1 e Mt-
NO OF .LOG. a eJ'O
alz[ or Lar NOW ON LOT cn TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP CLASS MAP PROCESSED BY
B/L PL
CONTRACTOR` r
ADDRESS J /r CONNECIION DATA
CITY T[L NO (� = 3 STATION DEPTH
STATE LID / UrFSR
L
C[Np[ No �/ cLwu 'I "' MANHOLE w[Ident[
NO DESCRIPTION OF WORK PER TYPE OF CONNECTION LENGTH Y
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P
PUBLIC$EWER O 85M
SEPTIC TANK $E[IAO.PIT ON PC NO -
'ITS AND/OR GRAINFIELD 0 $IB°O CO IMP NO Joe NO
HOUR[SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO 6
PRIVATE DISPOSAL SYSTEM Y SSM
CONNLCT ADDITIONAL SLUG OR 7INCROACHMENT
ITO p4pul RECORD INSTR NO DATE O
WORK TO HOUSE SEWER 0 $300 u
OVERFLOW SEEPAGE PIT DRAINII[LD
KXTH CESSPOOL DRYWrELL DONHOUMANHOLE
5300 ORSTIDENING BE
pCW[R^ ^' $f 00 CHM.NT (J
AL D,cZS' 3 z
z
11TO}VVDMrSPERMIT s z DD —
ALTMOHr4Al'ION TOTAL FEE S k5c.3 CONNECTION CHARGE rE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F[[
TRACTOR TO CONNECTTN[ (�pOt V[ DESCRI ED [EI{TING OW[LLIINGI
TO TEDPTHIS SL'C S �•JD IGF IS-//
OWNER AMOVADATE INSPECTOR 9 SIGNATURE
Ow ���LLL NEW HOUSE SEWER
OWNERS AG[ T
CADDITIONAL
ADDRESS
B.....UILDINO OR WORK
I H[RKBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SE ICTANK SEEP Prt(sl
w
ANO {TATE THAT THE ABOVE lE CORRECT AND ACOMPLY NO/Ow GRAINFIELD
WITH ALL COUNTY ORDINANCE$ AND pTATC LAWSWS REGULATING ❑
PLU YpING AND a[W IRS CESSPOOL ❑ DRYW[LL
1 HEREOY CERTIFY THAT I AM MOP -LY REGISTERED AND/°II ALTER REPAIR SEWEROR
LICENSED AS REQUIRED $Y LOS AN0 COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA
OR THAT AM TH[ LOA OWNER OF AND IM[ND TO AND
RESIDE IN THE AB DESC BD •(DENTIA '[RTY ABANDON HOUSE S[ I
SIGNATURE �/ /` —J BACKFILL{[FTI-TA.Ki
OF '[RMTTT[[ {[LP PITISI ❑ CESSPOOLS
CALM 0 C JACK R ALLEN
01 CK
y O CASH SUPERVISING MECHANICAL ENGINEER
4r^ 8 4 7 6� JAN26 1 0 0 5.00— a