HomeMy Public PortalAbout5642 ROSEMEAD BLVD_Sewer__ APPLICATION FOR PERMIT
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COUNTY OF Los ANGELES SEWS —SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU IL.D I NG
JOHN fit, LAMEIE, County Engineer ADDRESS
WILLIAM A, JENSEN. Sup t. of Building r t
LOCALITY /^
_.
NEAREST
R055 S
Ft3R APPLICANT TO FILL INLEGAL
_ ---
- - -- — - J
ESCR.PTIO.N_- _L.OT NO � e['} /-�._____--_ OWNER
/wc MAIL,
BLOCK TRACT �}-p1".,3'd� ADDRESS `$� ,,.Afir=1�a
NO. Ofi BLDGS. 8
SIZr OF LO_i ./ NOW OFt LOT _ ,�:..,, CITY ' TEL. N.O.
USE OS' DiSTRiCT NO. GROUP MAP PROCES ED BY
BUILDINGS BK
PG
CONTRACTOR
ADDRESS S,$ � � � CONNECT]
CITY p^9[' TEL NG-/q�' � ,¢Y STATION DEPTH UPPER- -
f
STATE
,�'. MANHOLE REFERENCEf-EG1:-.T RA"ION NO. OL NTY LOWEi{
No. PESCRIPTiON OF WORK FEE. ----- --O ECTIO ---`--..�
'TYPE e?=CONNECTION LENGTH FROM �
HJI15E SFWEFt Y. CURB P.L. M. ------ �`'«'M�
P.C.NO
SSFP,[C TAhK SEEPAGE-F3T OR -�-r-_i 0 I CO.IMP NO.F _'/ JOB NO.
-�
PITS AND-/OR DRAINFIELD @ Wi0.00
HOUSE SEWER CONNECTING TO
Tft_ k ROAD PERMIT NO.
I PRIVATE L'�15P4 AL SY STEM @ $300 L i- _ ;h
/t
CONNECT AUDI IONAL BLDG OR � .. AFF IDA 7 x. vt�S� gS�MLkT REC..RU INET NO I DAT£; -�-
/-
WORK TO HOUSE SSEWER - $5.00_E_�!( ✓
-OVERFLOW J E"ACE PIT,DRA N IELU
FXTN C£ OOL,D RYW ELL,MA JF1 OLE @ $5.00 __f__-Y
_._
f.._._ HWY.OR T.WIDCN;NG
ALTER.R PR R OR.ABA ND:7N tiOU €
£W ER 3P DISs'OSA L BY4TH_M C Y�9.00 __ ____ ._.___ ____ ______-- _. -._____ _---_
_ -. AiE ENCFO M.ENT
PERMIT NO
— — -- — — --- -- — IN0U;T AL
WASTE APPROVAL
OWNER'S � PERMIT 2y GO ___ ___ CHARGES �� -_
-- - ---` -__- --
CONNECTION CHARGE FEE ^>
AIT717HCRIZATION TOTAL FEE
HAVE. Al THiS DATE A CONTRACT WITH THE. HEREIN NAMED CON. R EIMBURHEMENT.FEE
TI2TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLINGp._/�{._'.__-..___-___-,_-__-_._:,_.___.---_._-___.___--
i THF. PV BL.!C SEWER. APPROVALS DATE I INSPECTOR S"-fGNATURE
SIGNED T"NIS-----DAY OW- ,-----------I y.- ------_._-------------1-------1.__- .
--
OWNER OF. Pp NEW HOUSE SEWER
D`N?d Ff2S.11GE,NT_--_u,,,..t-� - ��"'•�..•F___ __ C3NNECT ADDITIONAL
BUILDING OR WORK
EPTIC TANK.SEEP,PIT(S). I-
HEREBY ACKf`OdYLEDC. THAT I HAVE READ THIS APPLICATION AND/OR D,RAINFIELD
AND 'STA'?'E. T'PAT THE Ali3OVE iS CORRECT APED AGREE TO COMPLY
WI'tH AF-. COUNTY ORDINANCES AND STATE'. L.A.WS REGULA'I"t N-O
P i..�,!MF1I G AN^ JE"W'ERS. CE53POOL Ll DRYWELL Ll
t HERE HY E.RT:EY THAT I ANI PROPERLY REGISTERED AND/OR AL"E.R,REPAIR. .SEWER 6R j I
LICENSED AS REQUO,EO BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
C ALiFOR.N IA OR THAT ) AM 't 1:4E LEGAL OWNER OF. AND INTEND "fC --.
DIS:.ONNECT PLUG AND
RF51C IN, TNE. AE+.V= DS.Sa�Rif3FD RESIDENTIAL PROPERTY ER ABANDON HOUSE SEW
-- ——_--RE
a — — ----- ——------
.,, PE tMITl'E BACKFILL SEPTIC TANKS
SEEP,PIT(S) GF_SPOOLS
❑'I
VALIDATI®N ROBERT A. vvaar�
CK. M.o. CASH ,
SUPERVISING MECHANICAL ENGINEER
♦ f,
CE:E08 3-e2 .. 5y�
7EA64.2D APPLICATION-- FOR PERMIT
COUNTY OF LOS ANGELES SEWED—SEWAGE DI sPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADORES � sF-n� e° �.: P
WILLIAM A. JENSEkY, Supt of Building tom"
*OCAL ..�
fd£ARES
FOR APPLICANT TO_FILL ,IN CROSS ST.
DESCRIPTION LOT NO.
OWNER
MAIL
BLUCK TRACT .� ADDRESS
NO. OF SLOGS.
SIZE. OF L.QTIy:OW ilN LOT C:TY TEL, NO.
USE OF -
Bm-D NG ISJ,y 9 n:SMAP NO. ,ROUP P PRI C.E s 5 E,a 81
BK PG
ON'Rn,CTOR
A.00DATA
RcS. CONNECTION D
._ '�'�. �'_
C'T'S „' may. ,� ° -._. N STATION DEPTH
-- -' N0
j STA 7E MANHOLE REFERENCE -UPPER .._
REGISTRATION NO_ __ CO.NTY
LOWLR
'No"
O DESCRiF TLON � WOR FEE - �
-._I .__ .__._ -_.__... TYPE OF CONNECTION LENGT
R7 S' SEWFR.CONNEt-TiN=TO FROMY. _...___CURB P.L. M.L.M.LTO P.L. 0-
PUBLIC SEWER $5.00 I 0SEPTIC TANK SEEPAGE PIT.OR<.._ NO. -.--_—_
CO.IMP NO. JOB NO. 10
PITS AND/OR GRAINFIELD @ $10.04
HOUSE 5CW-cR CON NE':TING TC TRUNK PERMIT NO.
PRIVATE DISPOSAL SYSTEM I& $3:OG ROAD PERMIT NO.
CONNECT ADDITIONAl BLDG OR APFIDAY ITTWhIvru EA5EH6N� RECORD Ifr"TR NO. 1 DATE
WORK 10 H'7U5E SEWER $3.00 �
"OVERF1 OW SEEPAGE PIT URAINFIELD
-- - �-
X CESSPOOL..ESSPOODRYWE L,MANHO LE @ $5.00 HWY.OR ST.WIDENING
- -~ A SER.PE`AIR OR ABANDON 1+0_ISE
F WER OR D;SPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
i I PERMIT NO;
-T- ______ INDUSTR.'AL
1 WASTE APPROVAL
CHARGES
OWNER'S PERMIT 21 pp
_...__ _.__....___.
J.NNEC7'!ON CHARGE FEE
AUTHORIZATION TOTAL FEE
f HAVE AT THIS DATE A CONTRACT WITH THE. HEREIN NAMED CON- PREIMSURSEMENT FEE
RA._T' RTID CONNECT THE ABOVE DESCRIBED EXISTING DWELLING --- -}{ q�-- }�----- ---- --- - - --- — -- -
_O -, I,U E+L IC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED YHi`^.__ DAY
OWNER OR NEW HOUSE SEWER
OWT4ERS Ae.F N7._.,_ --'--_ __..--- --- ---- ---'-- -- -'----------'----.
CONNECT ADDITIONAL
BUILDING OR WORK -
SEPTIC TAMC,SEEP.PiT(S) _.1..,.
1 HERESY' A.KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DR.AINFIELD {
AND SIA7'E THAT THE ABOVE, IS CORRECT .AND AGREE 7'0 COMPLY
W11H. ALI_ COUNTY ORDINANC:FS AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL L] ORYWEiLL.
I HEREBY CERTIFY THAT 40PRLY REGISTERED AND./OR ALTER,REPAIR,SEW ER.
AM' E
OR I
ENSED AS. REQUIRED B LO NGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I '
CALIFORNIA OR THAT 1 A LEGAL CW NER OF AND I.. D T6 --- - "-:—'_--'-- - -'---_-'
< DISCONNECT FLUE' AND
RES!DE IN, THE A.. "-RIBED RESIDEN Pf?dF .. _
- ABANDON HOi35�SEWER
S1 Ca NA7U RF BACKFILL SEPTIC TANKS � ��
STEP, IT 45} � CESSPOOLS nl
VALIDATION_ .ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER,
CK. M.O CASH