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HomeMy Public PortalAbout6257 ROSEMEAD BLVD_Sewer__ L&fi-863 3•55 APPLICATION FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L Department of County Engineer County of Los Angeles BUILDING r" ADDRESS J WM.J. FOX, COUNTY ENGINEER CASSATT D.GRIFFIN, SUPT OR BUILDING LOCALITY FOR APPLICANT TO FML IN NEAREST y��y/^ /� ceoss sr. DESCRLEGIPTION LOT NO 1J 6 ��/ �D OWNER BLOCK TRACT ✓ 9 D Al- 'MAIL - ADDRESS NO. OF BLDGS. 47, r SIZE OF LOT NOW ON LO 6� CITY TEL. NO. USE OF BUILDINGS DISTRICT NO: I ~GROUP I BK MAP PG a CONTRACTOR , �,{r/ 4 ADDRESS J, CONNECTION DATA CITY - EL. NO STATION ,DEPTH TATE MANHOLE REFERENCE A � S UPPER REGISTRATIO N . ��❑ COUNTY !I �`� - - No. , DESCRIPTION OF WORK/ FEE 0Y TYPE 0 URB CTIOP L MEL GTO PTH ROM/� - HOUSE SEWER CONNECTING TO T PUBLIC SEWER - Q $ 3 50 - HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 _ CONNECT ADDITIONAL BLDG. OR y� /7� P C NO WORK TO HOUSE SEWER 1 00 �V CO IMP NO V JOB NO ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM f 00 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 `' SEPTIC TANK, SEEPAGE PIT OR PERMIT NO _ PITS AND/OR DRAINFIELD 00 - INDUSTRIAL - CESSPOOL-DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 - CHARGES � o0 OVaNER'S PERMIT' CONNECTION CHARGE FEE $ AUT14ORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTORHAVE TTOS CONNECT THE DATE ABOOVEWDESCRIBED EXISTINGA DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS =DAY OFA NEW HOUSE SEWER I ' CONNECT ADDITIONAL - OWNER OR ©JAS BUILDING OR WORK OWNERS GENT , `y5G �r SEPTIC TANK, SEEP, PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. _ SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF FF,/� DISCONNECT PLUG AND CALIFORNIA OR THAT 1 AM THE LEGAL OW ER 0 THE P,$04f� ABANDON HOUSE SEWEP ' ��CRIBED�S[D IIL PROP TY. , ;[_/,`�'_/Iy// BACKFILL SEPTIC TANKS Com' Y N UR I SEEP. PIT(S) ❑ CESSPOOLS OF PERMITTEE WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR _iC48 2_ 2 6 JUL 13 4 5 5 ,� v