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Home My Public Portal About5604 ROSEMEAD BLVD_Sewer__ 1 - f CasollO.B1 76AS4SD APPLICATION FOR PERM TBAB{ COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDINBUILDINGO LAMM Com1v EBqm{n ADDRESS WMA A IENSER, Sup i of S{[1dmV LOCALITY NEAREST F.ERA OR APPUC T I pIION LOT N � OWNER MAIL TRACT SE, ADDR NO OF BLOOS F LOT ryOW ON LOT CITY TELPD DISTRICT NO GROUP MAR PROCBa BY ING{ aBKAo(,JSS /Z CONNEwEL No {TATIon STATE UPPER flATION NO 7 COUNTY MANHOLE REFERENCE LOWER DESCRIPTION OF WORK FEE TYp¢oPc ttlOn LENGTH FROMdOUSE SEWER CONNECTING TO Y CURS P L M L TO P L OUBLIC{EWER O S!GO[Pi1C TANK 6CCPA0[PIT M PC NOITS AND�OR ORAINFIELD 0 51000 CO IMP NO JOB NOOE OUSE SMER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT O RIVATE OISroSAL 6YSTLM SIOGONNECT ADDITIONAL SLD. OR AFFIDAVIT R.RO [M[P[KI RECORD INSTR NO DATEORK TO HOUSE SEW[fl O $3 GO VERFLOW SEEPAGE PIT DRAINFI[LD XTN CESSPOOL DRYWELL MANHOLE Q {S00 y LTER REPAIR OR ABANDOX OU{ HWY ORST WIDENINGEWER OR DISPDS LBYST[M O $IGD STATHENCROACHMCNT PERMIT NO INDUSTRIAL WASTE APPROVAL Oww •ms PERM IS Z 00 CHARGES AUTHORIZATION TOTAL FEF �� CONNECTION CHARGE ME 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON RCIMBUR}SKM[NT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWEWEL ♦� DWELLING TO TO THE PUBLIC { ER DAT[ INSPECTOR a SIGNATURE SIGNED THIS DAY OF 19_ OWNEROR NEW HOUSE SEWER / OW NER{AO[NT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK I HEREBY ACKROWL[DOE THAT I HAVE READ THIS APPLICATION RA SCEP PITIS) AND STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO CON PLY AND/OR GRA WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWCLL ❑ I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED ANWOR ALTER REPAIR SEWEROR .LIC AS REQUIRED BY LOS ¢W ANGLES COUNTY AND STATE OF { AGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE OAL OWNER OF AND INTEND TO DISCONNECT PLUG AND REBID[ IN THE D[SCR REam TIAL PROPERTY ABANDON HOUSE SEWER SIONATURE BACKFILL B[PTIC TANKS ❑ OF PERMITTEE SEEP PITIS) ❑ CESSPOOLS ATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER LAC0 8 4 1 2 FEB 9 1 0 D 1 0.0 0 CE80a D,D.°, 76AS4 APPLICATION FOR PERMIT LES COUNTY TMENT OF LOS ANGENGI SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU ILDINa W�LtuOHN A LAPAW CE. EB R[T ADORES[ "WV ta A. JENSEer sBy7 Tf Im,ma ffA Loc,urY NEAREST FOR APPLICANT TO IN j D G, RIPTION LOT NO � � OWNER MAIL BLOCK TRACT ADORlJ6 NO OF SLOG[ BIZ! OP LOT NOW ON LOT CITY L NO 0,I OF DISTRICT NO GROUP MAP PROCESS °Y USE OF i OK PG CONTRALTO ADORES CONNECTION D A CITY EL NO O STATIO / DEPTH STAT! UP R REGISTRATION NO COUNTY MANEGE!REFERENCE OVIEIi NO GESCRIPTI OF WORK F[E TYPE OF rL !ION L[NOTH PR M HOUSE SEWER CONNECTING TO Y CURB J) P L M L TOP L PU BLICS[W[R Q °600 PC NO (J °EPTICTANK GEIPAGEPIT OR CO INP N I JOB NO BC PITS AND/OR GRAINFIELD [1000 HOUSE BEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM 0 $S UO CONNECT ADDITIONAL[LOO OR AFFI;�CROACHMENT InNNINNT RECORD IN[Tq NO AT[ WORK TO HOUSE SEWER 0 f600 OVERFLOW SEEPAGE PIT GRAINFIELD Z KXTN CESSPOOL DRYWELL MAN HOLE O °9 OO ALTER REPAIR OR A°ANDON HOU[[ HWYNING SEWER OR DIS OBAL SYSTEM 0 SS 00 STAT PERINDWOOCHARGES RD!FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSE M[ HT F[ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINGAPPRDVALJ TO THE PUBLIC °EWER GATE INSPECTOR[SIGNATURE SIGNED THIS�L.DAY OF IB OWNER _ OW NEOR �M/ NEW NOUS[StWLRo OW NEgB AGENT. CONNECT A KALIF ADDRESS BUILDING ORR WORK HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 66PTICTANK 69XP PIT(S) ANO °TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR GRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL [IFLU MB[NO AND SEWERS I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOG ANGLES COUNTY AP.ND °TATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 THE LEGAL OWNER OF IND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOV E[C RESIDENTIAL PROPERTY ABANDON HOUSE B[WER 01OFMATURt OF PERMITTEE SACNFILL SEPTIC TANKS ❑ [E[P PIT 16) ❑ C[BSPOOLB VALIDATION ROBERT A WOOD CK M O c,eH SUPERVISING MECHANICAL ENGINEER 8 2 3 6Q FEB 4 1 0 D 7.00- Awl" 7Q0- Awl"