HomeMy Public PortalAbout5814 ROSEMEAD BLVD_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL
7�IN �� LOCALITY
BUILIIN—ADDRENEAREST
!�'r AL, �����"� dl �.y��4 CROSS ST. —
LOCALITY f j - gip_ ." ✓ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST t A S
CROSS ST. F '
_ -� RECEIVED BY Ready for Inspection DATE ISSUED
MAIL I i l e I" � d
AODRESSy, �.j Z g j -fj7 L`CL_ s i_{� USE ZONE OCCUPANCY BK MAP PG
CITY7i' /jj •� 7EL.110. _ 04 /G
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB,NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. �j COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 1 PERMIT NO.
BLOCK TRACT _: r�' INDUSTRIAL
r WASTE APPROVAL
SIZE OF LOTNO.OF BLDG3.
�a'� . NOW ON LOT CHARGES
USE OF •-�
BUILDINGS CONNECTION CHARGE FEE
NO. I DESCRIPTI N OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. I DATE i BY .
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR i EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 i
ALTER OR REPAIR EXISTING NO' I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/pR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TRIdK,SEEPAGE PlT OR
PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
ICESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE,
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS _PERMITt I i oo Y. CURB -. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'$SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS:5, ....---- -----
OF. .. .��-_..._..19
NEW HOUSE SEWER
,gyp ---
OWNER OR s� CONNECT ADDITIONAL
P
OWNERS AGENTBUILDING OR WORK
) ---- • .,;.� _:a�..r�' .�/.
SEPTIC TANKSEEP.
ADORE SSfl� „j�,.�-r . �--.01 f- ,---- AND/OR DRAINFIELD
PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E)
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER _
AND STATE OF CALIFORNIA OR THAT i AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKSGi
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE_--- -----------------------------------.......................
.....__...--.
76A612D 663 1/53
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER � BUILDING
ADDRESS
BUILDING FOR APPLICANT TO FILL IN LOCALITY
ADDRESS. S'l 4Z .1�1 � i✓_df` CROSS ST.
LOCALITY t 811 c��' ,, DISTRICT N0. SERIAL N0. PERMIT N0.
NEAREST— A 3
_CROSS ST.,�- ��� °� „�
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL /
ADDRESS r: ,s t '^ J USE ZONE OCCUPANCY MAP
! 3 . 9�° 3tg
p � ( BK 'PG
CITY .j!5111r TEL.NO.g
CONTRACTOR
CO.IMP.NO.
ADDRESS
JOB.N0.
CITY TELAO• TRUNK PERMIT NO.
STATE
REGISTRATION NO. "COUNTY ROAD PERMIT NO.
LEGAL '
DESCRIPTION LOT NO. STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT
g N0.OF BLDGS.
- !—�LC� �✓ �, NOW ON LOT � CHARGES
USE OF j�
BUILDINGS Ep CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S 3.50 RECEIPT N0. DATE BY
HOUSE SEWER CONNECTING TO I
--PRIVATE DISPOSAL SYSTEM 1.00
. ..
CONNECT_ADD1710NAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 _
ALTER-bili OREPAIR EXISTING NO- DATE I BY
S£_WER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 { STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I o0
Y. CURB P.L. M.L.TO P.L.
� �
AUTHORIZATION ( TOTAL FEE I - -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER {�
SIGNED THIS...... ....__.DAY OF..a✓_- ..L.. .....1NEW HOUSE SEWER
OWNER OR p ' i ,f "5 CONNECT ADDITIONAL
OWNERS AGENF ,�'!,�-s'.�F,:r''_-.4. �.r..'+���..� ._
BUILDING OR WORK
f 1 SEPTIC TANK.SEEP.PIT(S)
ADDRESS T -,-. I<j� ....... &V O-_fj AND/ORDRAINFI£LD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL(] DRYWELL I]
CAT
IONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- _
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SIGNATURE SEEP.PIT(S)E] CESSPOOLS Q
OF PERMITTEE-------------_ - -----_---..---------------------_-------------
76A612D 663 1/53