HomeMy Public PortalAbout6246 ROSEMEAD BLVD_Sewer__ 16A6422DAPPLICA N FOR PER `, I
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COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL {
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION fADDRESS
ILDING t j f
.�JOHN A. LAMSIE, COUNTY ENGINEER LCOLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY
ARESTFOR APPLICANT O FILL IN oss sr(PRIN7 OR TYPE ONL'f)�
DESCRIPTION
LOT NO�t.'1 OWNER J,� F,fi
MAIL ,/ ��.y). l 9+ 9 7d - j
BLOCK_-.____ TRACTADDRESS .✓�y'?F,{
-- NO. OF BLOG5 - � ,ry
SITE OF LOT NOW ON LOT CITY J"`"`.� Y -:'g TEL. NO.4
—_._— -__-___y_____._
BUI OP DISTRICT NO. GROUP CLASS MAP P ESSED BY
-------
BUILDINGS s :a� u BK PS
CONTRACTOR //j �I 7 s
ADDRESS CONNECTION DATA
�I ,7 t. / x STATION
DEPTH
CITU il..._i f w-_' 0J TEL NO. 9 'J g.`.. 3 t.,+ �w ," / J..,.✓ ..� — ..
S1'A'lE } -� - _ LIC MA NN DLE REFERENCE� �t I (*��
., Yom.. ,¢_/ -y
LICENSE NO:.:_ s( CLASS _ .,YTS i�ls y, LOWER
ND. DESCRIPTION OF WORK FEE _ TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $5.00 P.C.NO.----___
SEPTIC-IA.NK SEEPAGE PIT OR CO !MP NOJ /y JOB NO.AND OR DRAINFIELD @ $10.00 .
HOUS E SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADD3T;ONAI BLDG OR — —�vAFFIDAVIT w0.1YE■TEpsEMENT RECORD.INSTR.NOT DATE
O —
WORK TO HOUSE SEWER $3.00
OVERFLOI}---
—_.W St EPAGE PIT,_- - DRAfNFIELD
DRLD ._
SSOO
E% N CESSPOOL.DRYWEE..L.,MANOLE @ ___ - l--" ------- ---_--_--
/7 THBANDON HOUSE —�— HWY._OR T.WIDENING
f I SEWER O. 9obBAL SYSTEM Q' $300
S
( t-
Yom- -
--- ---- - -- --- ----- -- - --- TATE ENCROACHMENT
Lu
PERMIT NO. — _.— CL
INDUSTRIAL cn
WASTE APPROVAL L
I
CHARGESTT�}O�/W'��Ny}ER7E'rys PERMIT ooAUMORIZATIONTOTAL. FEE CONNECTION CHARGE FEE -^— --
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -- --------
TO THE PIJBLIC SEWER,. - APPROVALS- DATE INSPECTOR'S SIGNATURE
SIGNED THIS . DAY OFA` :✓ .Tx'" ..'J,"' 18y�.;:� — ---- ------ --- --- -- ----
OWNER AGENT NEW HOUSE SEWER —
OWNERS ]_r,�,.. /._- ao"I a� `'. tet
=" � CONNECT ADDITIONAL
v / BUILDING OR WORK
ADDRESS `,,_ . ter.-.I r�nI �> ✓''r.:L. _. _ —_ -_ _
=7- L --- SEPTIC TANK,SEEP,P(T(S)
fw -
I HEREBY ACK_ LEDGE TFIAT'I HAVE READ THIS APPLICATION AND,OR DRAINFIzLD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS' REGULATING T— -- —
F'LUMBiNG AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS REO.UIRE0 BY LOS ANGLES COUNTY AND STATE OF .SEWAGE DISPOSAL,SYSTEM I
CA LI FORK 4A OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO ----
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. DISCONNECT PLUG AND -
ABANDON HOUSE SEWER
SIGNATURE
OF PER MtTTEE 9 ..x I�sC-y' ; ,f. _"—__ __ BACKFILL SEPTIC TANKS ❑
— - - 4= SEEP.PIT(S) ❑ CESSPOOLS ❑I
,''__V iLIDATION JACK R. ALLEN
/- SUPERVISING MECHANICAL ENGINEER
CK. r` M.0, CASH
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