HomeMy Public PortalAbout5834 ROSEMEAD BLVD_Sewer__ ; D
aE-669 TI-55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Depcatment of County Engineer
County of Los Angeles BUILDING :
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
Z" CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FORK NT TQ IN CROSS ST.
NEAREST
LEGAL
DESCRIPTION LOT N0,
BLOCK_ TRACT ADDRESS
NO. OF B GS, °' y
SIZE OF LOT NOW ON LUT_ -- CIT ;...r - +`,. 7TEL. NO.W
BU�OF
LDINGS�' �- - �`,.,+�`�> DISTRICTra''.G.RGUA 1 MAP
SK PG
CONTRACTOR_ y sem►-- _ 5 _ __ _ I L
ADDRESS, t r- �, —�" CONNECTION DATA
CITY --- TEL. NO.4 „�' ,� � " STATION - !, DEPTH
-------- MANHOLE REFERENCE. -yy UPPER
STATE - - --- --- --=;.c.e`'�_t•�XL ___ -
REGISTRATION NO. COUNTY
NG, i DESCRIPTION OF WORK FEE -- -------
----f _. - - -- -- -- - -- TYPE OFC °CTIGN LENGTH FROM
R ,!
HOUSE SEWER CONNECTING TO ' �f P.L. M.L.TO P,L _
PUBLIC SEWER @ S 3.52 I i. — ------- - --
SEPTIC TANK,SEEPAGE PIT OR �-
PITS AND/OR DRAINFIELD Vii.'; $3.001
OVER.-LOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN CESSPOOL,DRY dELL,FtAN_HOLE (n $2.00 CO, IMP. NO. +'_ JOB N0.
HOUSE SEWER CONNECTING TO - ----�;-- -
PRIVATE DISPOSAL SYSTEM ((t _ TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG. OR STATE ENCROACHMENT r
SEW
S
T
WORK O HOUSE ER fu; _
_ _ _.— 51.60 PERMIT NO.
ALTER,REPAIR OR ABANDON.HOUSE - ,
j
SEWER OR DISPOSAL SYSTEM c t,OC INDUSTRIAL
_.. WASTE APPROVAL
f
��c
_- CONNECAON CHARGE FEE
OWNER'S PERMIT � 1I{ 00
---- --- -
__.._..—....__-._-k REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE d I .2 _ APPROVALS DATE 11tlSr^ECTOR
I HAVE AT THIS DATE A CONTRACT WITH THEHEREIN NAMED CON- 1✓vr _ ;:GNnTURE
TRACTOR 70 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, NEW HOUSE SEWER
SIGNED THIS __ DAY OF fL �` 1
�..� - _� - CONNECT ADDITIONAL
OWNER UR ' `!"�� r" BUILDING OR WORK -
OWNERS ASEPTIC K S
EP7 C TANK, PIT($)
AVURE`S i_��+ a�;eF$ -AND/9R DRAINFIELD --- -
1 HEREBY ACXNOWLEDGE THA.. I HAVE READ THIS APPLICATION CESSPOOL[] DRYWELL.D
i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY- -.--.... ..-----.-.__-----=------.- ..__.__-------__--�_--
it H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
Pt bSBING
AND SEWERS, SEWAGE DISPOSAL SYSTEM
t HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND,C'R ---- - -----.._—._--_-_ --_-�— _ .__._--
�' DISCONNEC7 PLUG AI9D � �---.-_-.----�^-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE 01' 's I
CALIFORNIA. OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER I
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTI('TANKS C]
d;H
SIGNATURE` SEEP.PIT(S) Lj CESSPOOLS
OF PERMITTEE
�1
t
)OHN A. LAMB. E., COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. EC. 0.. 6ASfi -� -
1551 - 1 -4 5 4A 4.50
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