HomeMy Public PortalAbout6212 ROSEMEAD BLVD_Sewer__ APPLICATION FOR PERMIT
&E=663 91-Su
DIVISION OF BUILDING AND SAFETY S EIA/E R--SEWAGE D I S P OSA L
Department of County Engineer
County of Los Angeles BUILDING ✓d
.JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 7 s " ✓r
CASSATT UP
D. GRIFFIN, SUPT OF BUILDING LOCALITY ...a ,
NEAREST
- -- FOR APPLICANT TO FILL IN CROSS ST.
LEGAL —
DESCRIPTION LOT NO. OWNER �" ✓ �>�
BLOCK _— TRACT _SCI . MAIL
ADDRESS -�--
NO.OF B DGS. � �]/
SIZE OF LO �' CIIY 6a"€."' s`rY. C :..^TEL. NO, R ...
- — �°�..f __: NOW ON LOT--'---
USE OF DISTRICT NO. GROUP I MAP
BUILDIN-S
BK PG
CONTRACTOR
+ '
ADDRESS +y /' CONNECTION DATA
STATION _ DEPTH
CITY > TEL. NO,,..-= -,,,, :-
__---- -- .._ MANHOLE REFERENCE --
__ .. ❑ STATE
REGISTRATION NO. _- _ COUNTY y NO. I DESCRIPTION OF WORK FEE -- --- --_ .-- - -- �----
HOl3SE SEVER CONNECTING TO --- j Y_--�-- YPE OF CONNECTION LENGTH FROM
PUBLIC SEWER $5.50 ,-1 CURB P L. 'h4 L. TO P.L. `—
_
T - __.— -._O
SEPTIC ANS. SEEPAGE PIT OR T I
I PITS AND/OR DRAiNFIELD_ r $3.00 --
I------'----- .+
-= OVERFLOWSEEPAGE PIT DRAINFIFLD � � � P. C. NO.
EXTN..CESSPOOL,DRYWLLL,_MAI.H:LE ri A 2.00 - CO. IMP. NO. JC!3 N0.
--
-f HOUSE SEWER CONNECTING-,0 --- — - --- ---.T —_----- ----
PRIVATEDISPOSAL SYSTEM 6q" $1.130 '-RUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONALBLDG OR STATE ENCROACHMENT.,—
WORK
'-�-+
WORK TO HOUSE SEWER t1' $i.00 a" PERMIT i O, _ -.. '' T
ALTER,REPAIR OR ABANDON HOUSE.
INDUSTRIAL
SE�6 ER OR OtSPC`>AL eYS7EM � $1:07I _-WASTE APPROVAL
CHARGES
--- CONNECTION CI4ARGE FEE
OWNER'S PERMIT I, oto - -------- ---- -------- — ---
---- --- ----i----_ I ---- REIMBURSEMENT FEE
A � IOI$IZATION TOTAL °
�
i fAJF Tr DATE n -,014TRAC7 WITH HE t€ERc!nI NAMED CON- APPROVALS DATE INEC'TQR'SS:GNATLIRE
TRACTOR "'O COhrI THE ABOVE CESCRI,ELI EXISTING DWELLING
TO ThE PUB1,1C S C 4 NEW HOUSE SEWER
SIGNED THIS DAY OF NNF 'I
I ADDI7ICAL
�fi--
oVeNER OR -BUILDING OR WORK
OY Nf RS AGF.IrT _ SEPTIC TANK,SEEP,P(7(S) _ --- - ----
N/ P2'#iNd"iELD l_
I HEREBY ? K-NC'iLE GE THAT I HAVE READ THIS APPLICATION - SPOOLE DRYWELL ]
AND StA .E ..I r TKE EOVE !S CORRECT AND AGREE T.C. CON?PLY.
1-;TH ALL'
L, COON r ORDINAf CES AND STATE LAWS REGULATING- ALTER,REPAIR SEWER OR I i
PLUMPING Aft. SEWERS. - SEWAGE DISPOSAL SYSTEM I __
PROPER
-CAt�f-C�P�IX OR .'.r HAA?~II 'AM HE L ELES COU14TYWNER AND S AND/OR
TE F _DISCO N HOECT USE SEW LUG D
LiCE'vS !:S U 3GD
BY LOS ANGELES_''5 COUNTY AND STATE OF - —
DESCI t.D RES ENNA PROPERTY, BAC!CF III E.PT1C TANKS 0
SIGNATUPE SEEP If ; ESSP00L`Ir, I
OF PERMITTEE- - _
I
JOHN A.L,AM81E, COUNTY ENGINEER ALIDATION ROBERT A.WOOD, CHIEF PLEIG. INSPECTOR
CK, t4.C. CASH.