HomeMy Public PortalAbout6220 ROSEMEAD BLVD_Sewer__ DEP"1%lENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY 'PERMIT APPLICATION
COUNTY OF LOS ANGELES +I BUILDING
WILLIAM .J. FOX, COUNTY 'ENGINEER ADDRESS (� 2+ /V o f 7265:
F R APPLICANTETFILL IN NEAR LOCALITYeBUILDING
ADDRESS � dfy�E./,�� C.ROSSST. /� fv� �GJ' ;r
LOCALITY ��'` DISTRICT N0. SERIAL N0. PERMIT N0.
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NEAREST �' 4//! A , - �5 ��J
CROSS ST. RECEIV�E^D BB Ready for Inspection D'AT ISSUE
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OWNER CLri s7/q i L
MAIL / 'USE ZONE1 OCCUPANCY -i$s+?'
ADDRESS 't . BK PG
CITY Aik„7.. . ray TEL.NO 7/ , &�
CONTRACTOR iR.n,��w „ CO.IMP.NO. Zz'G
ADDRESS JOB N0.
CITY TEL.NO. ' TRUNK PERMIT NO.
STATE -
REGISTRATION NO. ® COUNTY- ROAD PERMIT NO.
LEGAL STATE'ENCROA'CHMENT
�
DESCRIPTION LOT N0 ey� _� PERMIT NO.
BLOCK TRACTy INDUSTRIAL c^ -
t�w � r WASTE APPROVAL ---��
SIZE OF LOT 6N0.OF BLDGS. CHARG
NOW ON LOT
USE OF
BUILDINGS /J--y,,t�, ` R.�sm�..e CONNECTION CHARG FEE
NO. DESCRIPTION OF WORK FEE
p HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLIC SEWER $ 3.50 J / RECEIPT NO. -DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 !'
CONNECT
WORK TO HOUSE ADDITISEWERONAL BLOO.OR
OUEISEWERLD6.OR 1.00 /1Q EXCEPTIO RECORDED
ALTER OR REPAIR EXISTING V NO. I D TE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER.
AND/OR DISPOSAL SYSTEM 1.06 CONNECTION bATA
SEPTIC TANK,SEEPAGE PIT OR ,; . _f/
PITS AND/OR DRAINFIELD 2.00 . STATION �TC� � Q DEPTH
CESSPOOL—D RY W ELL
SPECIAL CONDITIONS ONLY 2.00 i , ANHHO�LLE REFERENCE LOWER
TYPE OF,cONN€€CTION LENGTH FROM
OWNERS PERMIT ; 00 iCURB ) �� M.L.TO P.L.
AUTHORIZATION TOTAL FEE G -
I-HAVE THIS DATE CONTRACTED WITHTHE HEREIN NAMED:;
CONTRACTOR TO CONNECT THE ABOVE.DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER `J•
SIGNED.THIS_...13._...DAY OF—._— �`e Jos NEW HOUSE SEWER
OWNER OR dj �� CONNECT ADDITIONAL
OWNERS AGE T......
BUILDING OR WORK
w . -t vert>itTsart. SEPTIC TANK,SEEP.PIT(S)
ADDRESS....... _�_....._."Ly ..._._ ._.—.. .._.___._,._.....__.._. ..._... . AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE., _
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS, ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED: DISCONNECT PLUG AND,
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ' ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF-THE ABOVE DESR BED R SIDEN IAL PROPERTY: BACKFILL SEPTICTANKS1
SIGNATURE
��' SEEP.PIT(S)[] CESSPOOLS
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OF PERMITTEE.._ - .�.•-..__-. ...-�� ---• •--•-••_-._..—_
76A642A 063 7/53 V -