HomeMy Public PortalAbout6252 ROSEMEAD BLVD_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL `
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING �-
ADDRESS ��2 'Over �
FOR APPLICANT TO FILL IN LOCALITY
BUILDING � . � NEAREST
GO ��ADDRESS CROSSST �
LOCALITY / QBE ,,/�a��.✓ DISTRICT NO SERIAL N0. ?�,,[/PER9MIT N0. C
NEAREST ,LOfYG Ll rJJ A I4 / J
CROSS ST. -
RECEIVEDBY Ready for inspection DATE-ISSUED
OWNER ♦ 'IT//1 /�I , ���..7
MAIL
ADDRESS USE ZONE OCCUPANCY BK MAP PG
- ._
CITY 1TEL.NO. ' C70
I i
CONTRACTOR ���/ S��/ CO.IMP.NO.
ADDRESS ` y/f 5 6��� JOB.N0. —
CITY /1 �P_4 TEL.". V 7-- 444049 I TRUNK PERMIT NO.
STE
REGISTRATION NO. 7"t'(O �] COUNATTY, ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. D SO . � � STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACTgm ���� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTQ */6_3 NOW ON LOTOF S l�
CHARGES
USE OF �E✓s f CONNECTI CHARGE FEE
BUILDINGS
NO.' DESCRIPTION OF WORK FEE
REIMBURSEMENT
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO 1 S
PRIVATE DISPOSAL SYSTEM 1.00 1
CONNECT ADDITIONAL BLDG.OR + EXCEPTION RECORD
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
NO. DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
,DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR y /
PITS AHD/OR DRAINFIELD 2.00 STATION e�7 DEPTH C�00,
CESSPOOL—DRYWELL �� 3
SPECIAL CONDITIONS ONLY 2.00 LMANHOLE REFERENCE
[o '7 3 ' Op um-SR— LOWE
TYPE OF CONNECTI LENGTH FROM i
OWNERS PERMIT ; I I X00 Y. CURB P L. M L TO P.L.
AUTHORIZATION I 'TOTAL FEE I .S
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
_ _._19._.. NEW HOUSE SEWER 7
SIGNED THIS...._....._.......DAY OF_..._._�._____ ¢-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.14/
_ BUILDING OR WORK
Tom- SEPTIC TANK,SEEP.PIT(S)
ADDRESS........................---_--_--------..----.--.---------••----------------------- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT, I 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 DESCRIBED RESIDENTIAL PROPERTY. I BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)[] CESSPOOLS
�
OF PERMITTEE - - ----------------------
76A642A'663 7/53 �,