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HomeMy Public PortalAbout5916 ROSEMEAD BLVD_Sewer__ '6A -66 Egos Ir.vs APPLICATION FOR PERMIT 1 E-663 DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS PIC CASSATT ID. GP.i.FFIN, SUPT 07 BUILD.;.NG LOCALITY � y , NEAREST FOR APPLICANT TO FILL IN CROSS ST= ter-- ---- -----____.---- LEGAL .�, DESCRIPTION LOT NO. OWNER MAIL BLOCK _ TRACT 4 . �, ^_-_- _'ADDRESS .r J=am 14 0.OF BLDGS, CITY TEL. NO, SIZE OF LOT ,, - .,a NOW ON LOT ,�- _ USE OF ✓' _ ,y —_- - — DISTRICT NO. ; GROUP MAP BUILDINGS ,d«4 .'� 'l*_j ._ — I BK PG U CONTRACTOR ADDRESS _ _ CONNECTION DATA _ STATION 'Y"' � DEPTH CITY CITY TEL. NOy �,d - --- - - -- - J"'� ✓- . MANHOLE REFERENCE -A — P ER" REGISTRATION NO. ,�'` _ ,. ❑ COUNTY NO. DESCRIPTION OF WORK FEE ------ ------ ------- .__�._--.. ---- ---- --- ------ - --- --- TYPE OF COY CTION LENGTH FROM HOUSE SEt1ER CONNECTING TO ' Y. R P.L. M.L.TO P.L, a , PUBLIC SEWER ---�a� $3.5 i ----- -_- -- --- - — _. SEPTIC TANK SEEPAGE PIT OR 1 PITS AND/OR DRAINFIELD Ia: $3.00 OVERFLOW SEEPAGE PIT DRAINFIELD ! P,103 C.No, EXTN.,CESS POOL,DRYWEL L,MAN HOLE C $2-.00 CO. 15iP. N0, , i . HOUSE SEWER CONNECTING TO _ PRIVATE DISPOSAL SYSTEM - fLd $1.CO i TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR ,,TATE ENCROACHMENT -. (' I WORK TO HOUSE SEWER ---.--,-- Gt $s.CO PERMIT NO, _.. `--- o ALTER.,REPAIR OR ABANDON HOUSE 0C1 -SEWER OR DISPOSAL SYSTEM In INDUSTRIAL $i. I WASTE APPROVAL CHARGES I1 CONNECTION CHARGE FEE OWNER'S PERMIT --- --- --------- $ -. O�-_. REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE _ e f DATE INSPECTOR�SSiGNATURE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- —_-----._---..___----_APPROVALS----.--I _-- —i_----- ------_--__-_-- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO I'HE PUBLIC SEWER. s NEW HOUSE SEWER SIGNED THIS.= .DAY OF y,G�° 1 CONN-CT ADDITIONAL '" �l OWNER OR S jl �' BUILDING OR WORK ----- OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDR'CSS :� ^( �." ,r"' � AND/OR DRAINFIELD --—' --- .............. -- — - —.__--'- i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR j PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THA T I AM PROPERLY REGISTERED AN I)` DISCONNECT PLUG AND jf'- ----"---- LICENSED AS REQUIRED B' LOS ANGELES COUNTY AND STATE OF ABANDON CALIFORNIA OR THAT I AAM THE LEGAL WNER OF THE. ABOVE ABANDON HOUSE SEWER ----.__.�_-_--.-- DES.CRiBED RESIDENTIAL,,,'' ERTY. BACKFILL SEPTIC TANKS SIGNATURE ` SECP.PIT(S) El CESSPOOLS Lj OF PERMITTEE �G��. z ✓ . IOHN A. LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. H.0. CASH D i E-663 1f-55 APPLICATION FOR PERMIT &E•8 DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSj 4_-p- CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY _ FOR APPLICANT TO FILL IN NEAREST o LEGAL — � -- DESCRIPTION _LOT N0. `�i'/ ,�''f L"+�, OWNER BLOCK TRACT w''+ AD R ADMAIL -- - ----- NO.OF SLOGS. CITY TEL. N0. SIZE OF LOT. NOW ON LOT _ USE OF ,� DISTRICT 0. - GROUP MAP BUILDINGS !°C_'�°'r�✓�t��`,+"1 �c. -' ,n ....�� i BK PG CONTRACTOR ,�✓'a. +., ,� fd�' y 4— ADDRESS ��� '� ', �: o _ CONNECTION DATA STATION __ DEPTH _ 1_CIT_Y '�-y:--,7 ,ry EL. N0. + a- MANHOLE REFERENCE .___UPPER <i ;. LOWER - REGISTRATION NO. ,�- � ❑ COUNTY No.j_ OF WORK FEE ---- --- TYPE OF COHNE.CT'iON LENGTH FROM HOUSE SEWER CONNECTING TO - Y CURB P.L. M.L.TO P.L. 1 PUBLIC SEWER_ _ _ @ $3.50 _ --=— _ ----- -- SEPTICTANK SEEPAGE.PIT OR _ PITS AND/OR DRAINFIELD - C $3.00, _I OVERFLOW SEEPAGE PIT,DRAINFIELD P. C, NO. - E TN.,CEs'SPOOL,DRYNELL,IAANiiOLE (r,, S 2.QQ CO. IMP. NO. JOB N0. _- -._ - —_------ - ---I----- ----- -- HOUSE SEWER CONNECTING TO PRIVATEDISPOSAL SYSTEM C $1.00 1 TRUNK PERMIT NO, ROAD PER A1T N0. 1— - -� ---- ------�-- L,.—_ --- --- -- ---.-. CONNECT ADDITIONAL BLDG.OR - —__- STATE ENCROACHMENT _ WORK TO HOUSE SEWER - ----- �.s.t=OU s--,r� � _PERMIT NO ALTER,REPAIR OR ABANDON HOUSEINDUSTRIAL I - — SEWER OR DISPOSAL SYSTEM (r $f.Ul` � WASTE APPROVAL - >_' / —'y'�— �✓ I ----- --- -CHARGES--------- -- r Zr _ CONNECTCHARGE FEE Y' s OWNER'S PERMITDO _ -- -- AUTHORIZATIONfiOTAL FEE � —�,�� REIMBURSEMENT FEE t+ APPROVALS DATE I[NSPECTOWS SIGNATURE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING — I TO THE PUBLIC SEA ERR -^- -.,� NEW HOUSE SEWER SIGNED THIS CONNECT ADDITIONAL I OWNER OR i, BUILDING OP.WORK OWNERSAGENT ' - SEPTIC TANK.SEEP PITiS - ADDRESS-- AND/OR ORAINFIELD I HERESY ACKNOVILEDGE THAT I HAVE READ 7H15 APPLICATION I AND STATE I'HA THE ABOVE IS CORRECT AND AGREE 0 COMPLY _CESSPOOL t- DRQ^./ELLS WITH ALL COUNTY ORDINANCES AND STATE LA'NS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. _SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND STATE OF —� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND I s ABANDON HOUSE SEWER THE CALIFORNIA OR THAT I AM .HE LEGAL OWNER OF THE ABOVE - - -- -- -- -�— -------.—.._ DESCRIBED RESIDENTIAL PfL9PERTY. BACKFILL SEPTIC TANKS SIGNATURE. . - SEEP.PIT(s) L; CESSPOOLS Y -OF PERMITTE.. y°� I JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLE3G. INSPECTOR CK, M.© ASH