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Home My Public Portal About5665 ROSEMEAD BLVD_Sewer__ 6A b<2° —CE8°e—'°_" APPLICATION .F PER% , COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS LOCALITY Ffi./j, �./ ` 4— NEAREST ! FOR APPLICANT TO FILL IN CROSSSST. ( s -- - LEGAL DESCRIPTION LOTNO. OWNER 5 -.lv.,� ._�. MAIL BLOCK_ TRACT I - ADDRESS •E L' NO. OF BLDGS. rr r� SIZE OF LOT �� -fit e�NOW ON LOT CITY i I� 4 TEL. USE OF BUILDINGS DISTRICT NO. GROUP SK MAP PS S$ED BY CONTRACTOR ADDRESS /) Cj A+ (✓ ! CONNECTION DATA STATION /� DEPTH CITY < - r TEL. NO. �' (.� STATE LIC MANHOLE REFERENCE. / UPPER LICENSE NO,._ _ CLASS 9b -Y-- y ., NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LEN._GIrH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER $7.00 P.C.N : SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. JOB NOO.�C^' PITS AND/ DRAINFIELD ® $10.00 HOUSE SEWERCONNECTING 70 TRUNK PERMIT NO. ROAD PERMIT NO. a PRIVATE D15POSAL SYSTEM $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVE■ [ASEM ENT RECORD.INSTR,NO. DATE U WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD _ /DC EXTN..CESSPOOL.DRYWELL. @ $5.00 HWY.OR ST.WIDENING O ALTER.REPAIR OR ABANDON HOUSE F- SEWER OR DISPOSAL SYSTEM � $3.00 STATE ENCROACHMENT W MANHOLE $7.00 PERMIT NO, a ------- -- ------ to INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ gym`0 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIM BURS'EMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING — -- TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF :I° 19�4 _ /! OWNER OR NEW HOUSE SEWER OWNERS AGENT - CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION .AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU MEt ING AND SEWERS. CESSPOOL [IDRYWELL ❑ I He: CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER-OF. AND INTEND TO DISCONNECT PLUG AND RESIDE /N, THE ABOVE, ESC R! RESIDEN ,(eL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTE —_ BACKFILL SEPTIC TANKS ClE '�' -�� SEEP.PIT15) ❑ ESSPOOLS ❑ VALIDATION CK, M.0. CASH � '6A 6420 -CE808 - 10-71 APPLICATION ° OR PERM COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADORE5S R YFOR APPLICANT TO FILL IN LEGALf}.� - DESCRIPTION LOT NO. OWNER �._. r � �^L!/ v • a7 MAIL BLOCK TRACT ry ADDRESS �j NO. OF BLDGS. � • SIZE OF LOT . e %In NOW ON LOT CITY s TEL. NO USE OF BUILDINGS j. , `T' DISTRICT N0. GROUP MAP /f .d$A4CESSED BY CONTRACTOR z.� � _ ,� �L) i �/Z-- �,. ,: ADDRESS •J '•' ° CONNECTION DATA CITY ! TEL. NO. ` a"3 STATION vL- rA'•y DEPTH T v STATE LIC MANHOLE REFERENCE UPPER LICENSE NO. _ CLASS ..-- �{^'t '�"-. LOWER NO. 1 DESCRIPTI N OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO --�-y Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER 0 $7.00 V SEPTIC TANK.SEEPAGE PIT OR P.C.NOOB NO. (k., '9 .^'"'v-� PITS AND/OR DRAINFIELD $10.00 CO.IMP. NO. J HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 -_ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 1 WAIVER EASEMENT RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD Ix EXT N..CESSPOOL.ORYWELL. $5.00 0 HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE F- SEWER OR DISPOSAL SYSTEM a $3.00 T w _STAT ENCROACHMENT MANHOLE PERMIT NO. Q $7.00 INDUSTRIAL WASTE APPROVAL Z CHARGES OWNER'S PERMIT s r CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE 1 4- 1HAV AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE I NSPECTOR'S SIGNATURE SIGNED THIS _QDAY OF !- 19 p� OWNER OR /yam/,,,y//// �,� ,.� NEW HOUSE SEWER •f;,- .r-"'--�:+'--^- OWNERS AG£N7, 15a 'z ',E,", .r!S ""'"1` CONNECT ADDITIONAL ' �7 BUILDING OR WORK ADDRESS - SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,RCF IR.R,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND REST DE IN, THE ABOVE, DESCRIBE RESIDENTIA PIR OPERTY. ABANDON HOUSE SEWER SIGNATURE / .. OF PERMITTEE_ _� BACKFILL SEPTIC TANKS O ❑ SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION c_ .' M.0. CASH �JL ;eg1v ® 15.UU • 16A 642D-CE808-10-71 APPLICATION FttPERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY .. _,.' row FOR APPLICANT TO FILL IN CROSS LEGAL DESCRIPTION LOT NO. OWNER MAIL 9 BLOCK TRACT ADDRESS '--" ! NO. OF BLDG5. ) - 512E OF LOT [}--f".7r�' NOW ON LOT CiTYf-C' TEL. NO./7`/ 6-,f/ 3 USE OF Y"7 BUILDINGS 1.I-f'' J D15 TRICT N0. GROUP MAPCESSED BY SK PG CONTRACTOR x I ADDRESS f t'' w l t 2 CONNECTION DATA_ _ c {`�- / ,� STATION a I � — DEPTH C TEL NO!,t12 F ,41 ii' `,' I �,f TT�� STATELIC MANHOLE REFERENCE/� y y sCt� LICENSE NO:, ' GLASS 73-1 V ""--p(J /(�.G�•-� LOWER NO. DESCR PTION O`'�F'WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER 6 $7.00 ' SEPTIC TANK,SEEPAGE PIT OR P.C.NO. '10 -2 PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 4 PRIVATE DISPOSAL SYSTEM $3.00 0 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO —DATE 0 WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD G' EXT N..CESSPOOL.DRYWELL, ® $5.00 0 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM -$3.00 ---- V —.---.—. STATE ENCROACHMENT UJ MANHOLE $7.00 PERMIT NO. C, — H --- -- - INDUSTRIAL WASTE APPROVAL Z_ CHARGES OWNER'Sl PERMIT` S 3 00 AUTHORIZATIONT TOTAL FEE I CONNECTION CHARGE FEE -- I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSP C 5 SIGNATURE SIGNED THIS 2- 1 DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT" � IBJ'...✓ "'tC'_- �v J' __--fir -.�:"1.; CONNECT ADDITIONAL ADDRESS_ BUILDING OR WORK SEPTIC TANK,SEEP,PIT(5) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING 4 PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL i AL HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR TER,REPAIR,SEWER OR LICENSE DAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGEDI SPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL.PROPERTY. ABANDON HOUSE SEWER SIGNATURE �. OF PERMITTEE x.� f ;'y _ BACKFILL SEPTIC TANKS ❑ + x?T'—' SEEP.PITS) ❑ CESSPOOLS ❑ VALIDATION CK: M.O. CASH 3 4 3tit-IES_ 29 1 0 !) 1 5.0 0 Avv