HomeMy Public PortalAbout6011-6015 ROSEMEAD BLVD_Sewer__ 7A848
.e•as APPLICATION FOR PERMIT 1
.seoeCOUNTY OF LOS ANGELES
SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN.Sup't of Building LOCALITY
FOR APPLICANT TO FILL IN NEAREST
_CR05S ST.
LEGAL .T. —
DESCRIPTION LOT NO., I' , ` . , - ,. _OWNER t'141-
BLOCK TRACT t MAIL
r � ADDRESS -•"' o NO.OF BLDGS. " s 3
SIZE OF LOT" NOW ON LOT CITY t' 5 - TEL.NO.
USE OF a'
BUILDINGS ) CISTRICT NO. 'GROUP MAP PROCESSED BY
CONTRACTOR
+� F
ADDRESSCONNECTION DATA
CITY >' 'TjE�L.N0. "f ' STATION DEPTH
REGISTRATION N0. �( 14 t°��* e� COUNTY u STATE MANHOLE REFERENCE _TUPPER�'
NO. I DESCRIPTION OF WORK FEES LOWER-
HOUSE SEWER CONNECTING TO
PUBLIC SEWER $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAJNFI5LD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ 2.00
HOUSE SEWER CONNECTING TO P,C.NO.
PRIVATE DISPOSAL SYSTEM a $1.00 CO.IMP.NO. JOB NO,
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0.
WORA:TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT -
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OAR'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AITTgIORIZATION TOTAL FEE 9REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCfIIBED EXISTING DWELLING
TO THE PUBLIC§EWs
SIGNED THI. DAY OF r�.r�..� 19. _N�w HOUSE SEWER A _�
OWNER OR. ° CONNECT ADDITIONAL
OWNERS AGEN er i v a,. BUILDING OR WORK
SEPTIC TANK,SEEP,PIT($)
ADDRESS " AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFABANOUN HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF TIW ABOVE;
DESCRIBED RESIDENTIAL PROPERTY. :BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS { ��
OF PERM iTTE $ ;'':b
®� fi _ 'VALIDATION. ROBIE aT A.WOOD,AL, a.R. ' B ,; SUPERVIAPINQ M ZCHANICA.i..ENGINEER.