HomeMy Public PortalAbout5824 ROSEMEAD BLVD_Sewer__ ,6A
E-663 11.55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COIJNTY ENGINEER ADDREss
J CASSATT D. GRIFFIN, SUPT OF SUIL.DING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN _CROSS ST..
t Ddu I -&, t �f 4 -k-
LEGAL f DESCRIPTIO/ NO $_ � '_---- ...y-- OWNER "- ,'Y. t�,+ -7-
BLOCK TRACT MAIL
W ..�:� -ye..p�' , rte ADDRESS �.a,.• -
�' --.N0. OF BLDGS. CITY "CEL h0,
SIZE OF LIT d�T' m _ „i1 _ NOW ON LOT `` y. - ..>''
to e' a..a t.
USE OF �s -� .-- . GROUP MAP
BUILDINGS l.��t_ :-. --�' z _
DISTRICT N0
._ -. __ _ - H BK
'--�----- '-r r-- I G
..� Irk
CONTRACTOR t` f
Sc�: ..�- - - - - -
ALT[)R=ss CONNiEd Ni DATA
,� •®` STATION d DEPTH
CITY-- 4�. .-_d' TEL.I'm - -- -- -.t-- --- - --_ --.
�- 11 --- �` MANHOLE REFERENCE
.2" STATE ------ --
REGISTRATION N0. 9 ' --` yrs'L; COUNTY - +,` -I,PPER
N0. DESCRIPTION OF WORK FEE - - ...<' ---------_- r
-- -_NECiING TO--- - -.---- - -.----- -- TYPE OF E lON LENGTH FROM
HOUSE SFWEk ONY• URB EITION
L, M.L.TO P.L. r°` -
PJBLIC S°1JER @ $3.50_ "''x_( -------- - >>
I SEPTIC TANK,SEEPAGE PIT OR j
PITS AND/OR DRAINFIELD Q' $3_.00! ------------`------_------
OVERFLOW SEEPAGE PIT,DRAINFIELD x-., P. C. N0.
_ EXTN.,CESSPOOL,DRYSv ELL,MFN,'IOLE Cd-v $2.00 _ CO.-'IMP.-NO._ ,,,may --', ;OB NO.
_r HOUSE SEWER CONNECTING 70 �- "- -' -- - -�
PRIVATE DISPOSAL SYSTEM C'L $1 0 I RUNK PERMIT NO - _ ROAD PERMIT NO.
- - --- -----------
CONNECT ADllIT?O-ASkL BLDG- . SKATE ENCROACHMENT 1--��-J WORK TO HOUSE SEWER a $_1.0_C --- PER-MIT N0 - -- -�+'_�
ALTER,REPAIR.OR ABANDON HOUSE INDUSTRIAL --_-
! SEWER OR DISPOSAL SYSTEM _---_- J $1.0G_j. WASTE APPROVAL
-_..._ _.�- `-----------------.--- CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT1 00 ---------------- -------- ---- ---
AUTHORIZATION TOTAL FEE '--
'S - ------ REIMBURSEMENT FEE.
y _ .
I AVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON-' _____APPROVALS_ __I___DATE_ _(INSPECTORS IG;IA-_URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING, DWELLING
TG ";HL PUBLIC SEWER. NEW HOUSE SEWER '
SIGNED THIS DAY Or N*�"o `3 t9_ �._ CONNECT ADDITIONAL -- -- – -
OWNER OR y"'j`j"�_ i .,,,� ,/ BUi LDING OR WORK
OWNERS AGENT �–^ --- ,PIT( .._._
. - - – -- SEPTIC TANK,SEEP RfTtS) ! f
:' ANO/OR DRAINFIELD
-
ADDRESS_ �y e _ t'7`ie.a kyt"'Ce. s. — –----_
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 'APPLICATION CESSPOOL[] DRYW'ELLLO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEld i
HEREBY CERTIFY THAT 1 AM PROPERLY R -;}TERcD Af IWOR `DISCONNECT PLUG AND l
LICENSED AS I'LOWRED BY LOS ANGELES CcwNTY AND STATE OF ABANDON HOUSE SEWER
OR THAT I AM Tr'E LL L. WNER OF THE ABOVE - – 1-- -----_–
DESC'I HED RES TI PROPERTY; 6 Z BACKFILL SEPTIC TANKS 0 i
-
SIGIdA.fURE SEEP,PIT(S �J CESSPOOLS r..:I --_-- --'--.^--__-'-
- OF PER
"
I
10HN A.LAMBIE.Com,, rY ENGINEER 6 ALIDATION ROBERT A.WOOD.CHIEF PLBG. INSPECTOR
'6A6421)
X806 it-se APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER "UL NG Z?
BUILDING AND SAFETY DIVISION ADDIOE'SS
10HN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY 'z
14EAFZEST �'j
FOR APPLICANT TO F711 IN CROSS ST. /t�t-_�
if L
DESCRIPTION LOT NO.
LEGAL
OWNER
BLOCK TRACT MAIL
ADDRESS t
NO.OF BLDGS.
SIZE.OF LOT -K- NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO. OUP I I
BUILDINGS MAP PG PRO S�
R BY
BK
CONTRACTOR• 4-
ADORES CONNECTION DATA
CITY AL.NO. STATIONDEPTH_
ATE MANHOLE REFERENCE
REGISTRATION NO. COUNTY
NO. DESCRIPTION OF'WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00
TYPE QFt0"E4TION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P,L,
PITS AND/OR DRAINFIELD $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN_CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER IG TO P.C.NO.
SYSTEMPRIVATE DISPOSAL @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER Cul $1,00
ALTER REPAIR 0 11 ABANDON HOUSE
�r
Dj��0STATE ENCROACHMENT,
SEWER
OR SA L SYSTEM
YST r m $1,00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL CHARGES
OWNEWS PERMIT s 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE =rc-77 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN _NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXJSTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. ._--.---
SIGNED
) j 11 ---SIGNED THIS. DAY OF_ .: � -I �
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS BUILDING OR WORK
IT(S)
SEPTIC TANK.SEEP.P
ADDRESS -AND"OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAI'I )41AVE READ THIS A"PPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
I HEREBY CERTIFY,THAT I AM PROPERLY REGIST;RE.,D, AND/OR SEWAGE DISPOSAL
'OF
LICE AS REQUIRED BY 4,9S�ANGEL COUNTY�1�%�TA DISCONNECT PLUG AND
S THE SEG "L le�eiv �1169BANDON HOUSE SEWER
-�'f OWNE rH Ov
CALI'FO OR TH T 4-A
DESCR 5191DE Rv BACKFILLSEPTIC TANKS
r SEEP. PIT(S) Q CESSPOOLS
OF S -'TEE c
OF VAUDATION ROBERT A. WOOD
C& IL C. /CASH SUPERVISING MECHANICAL, ENGINEER