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Home My Public Portal About6263-6267 ROSEMEAD BLVD_Sewer__ r 2/70 76A6A 642D APPLICATION FOR PERMIT 6 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FBD JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS. SUP T OF BUILDINGe� G� ClT FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) DESCRIPTION LOT NO OWNER /'T` Q �✓ 7. -MAIL BLOCK TRACT . dL ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY (�[ ' TEL NO USE OF DISTRICT NO GROUP CLASS MAP PROCESSED BY BUILDINGS �L L SK p� r` L 2 ..ONTRACTOR �D�S' Lis �E� fD ADDRESS I !UD ,E CONNECTION DATA CITY - �, TEL NO S� STATION DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FkbM HOUSE SEWER CONNECTING TO Y . CURB P L ML TOPIF PUBLIC SEWER @ $S 00 PC NO SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD @ $1000 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM $3 00 TRUNK PERMIT NO ROAD PERMIT NO > CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER I-EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ 5300 (J OVERFLOW SEEPAGE PIT DRAINFIELD E%TN CESSPOOL DRYWELL MANHOLE @ $500 HWY OR ST WIDENING O STA BANDON HOUSE SEWER YSTEM $300 F I STATE ENCROACHMENT • u PERMIT NO N.I INDUSTRIAL dh WASTE APPROVAL OWNERS PERMIT s 2 Oo CHARGES AUTHORIZATIONI TOTAL FEE CONNECTION CHARGE FEE ` I HAVE AT THIS DATE A CONT%' ITB.HE HER I NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONN�Tq AB E% T NG DWELLINGTOTHE PUBLIC S APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DA 19_ OWNERS AGENT R' NEW HOUSE SEWER CONNECT ADDITIONAL q ADDRESS l 10 �• j BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORD NCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY HAT PR E Y RE T AND/OR ALTER REPAIR SEWER OR LICENSED ,AS REOUI D BY L AN COVN STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH I AM HE LEGA OWNER F N INTEND TO DISCONNECT PLUG AND RESIDE IN THE A VE DES RI D SIDENTIA O ERTY ABANDON HOUSE SEWER /y SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTE ❑ SEEP PIT(S) ❑ CESSPOOLS VALIDATION JACK R. ALLEN OCK M 0 CASH SUPERVISING MECHANICAL ENGINEER CK M O CASH 199 0 6 x 2 6 1 5.0 0 - I 3"64 76A643-64 APPLICATION FOR, PERMIT 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEARE FOR APPLICANT TO FILL IN CROSS SST a LEGAL DESCRIPTION LOT NO OWNER MAIL Y BLOCK TRACT � � ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY BK PG GON7RACT0 � � t J�� F ADDRESS% C)O ECTION DATA C Y "TEL NO .3f STATION 4 DEPTH TATE - _ �! __ _ - - -_ UPPER y MANHOLE REFERENCE REGISTRATION NO 71 COUNTY q:mmmmmm NO DESCRIPTION OF WORK FEE TYPE OF ON LENGTH OM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P PUBLIC SEWER ® $S 00 SEPTIC TANK,SEEPAGE PIT OR �� D P C NO PITS AND/OR DRAINFIELD S1000 CO IMP NO JOB NO D_ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIV[R I [ABrM[NT RECORD INSTR NO DATE IX WORK TO HOUSE SEWER ® $300 Q OVERFLOW SEEPAGE PIT,DRAINFIELD V CESS POOL,DRYWELL,MANHOLE @ $s 00 ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING (L O_ SEWER OR DISPOSAL SYSTEM Q $3 00 STATE ENCROACHMENT PERMIT NO — / INDUSTRIAL WASTE APPROVAL CHARGES LI WNERS PERMIT S 2 00 THORIZATION TOTAL FEE OO CONNECTION CHARGE FEE VE AT THIS DATE A CONTRACT WI H E HE NAMED CON- REIMBURSEMENT FEE TOR TO CONNECT THE ABOVE DE CRI D E IST N D ELLIN HE PUBLIC BE APPROVALS DATE INSPECTOR'S 81GNA`TU RE ED THIS DAY F - 19_ p pp /1 g9.�iv/�� •m`y �� ER OR / / NEW HOUSE SEWER C ERS AGENT �!/ L� CONNECT ADDITIONAL e f v o BUILDING OR WORK ESS EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP,PIT(S) STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BING AND SEWERS CESSPOOL ❑ DRYWELLHEREBY CERTIFY TH IAM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER ORNSED AS REQUIRE Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM FORNIA OR THAT M THE GAL OWNER OF, D INTEND TO DISCONNECT PLUG AND DE IN, THE AB DESCR D R 5 DENiIAL OPERTYABANDON HOUSE SEWER ATUREBACKFILLSEPTIC TANKS PERMITTEE SEEP,PIT(S) ❑ CESSPO❑OLJ VALIDATION ROBERT A. WOOD CK M O SUPERVISING MECHANICAL ENGINEER CASH JACO 9 2 5 7 JAN 31 1 0 A 7.0 0- V CE8082/70 PERMIT FOR SEWER 76A 642D COUNTY OF LOS ANGELES SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. (PRINT OR TYPE ONLY) - - r __-LEGAL ,..-. ,.. DESCRIPTION LOT NO. - t OWNER R �� }� MA3L BLOCK TRACT ADDRESS 'NO.J OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. ' BUILDINGS - '�M ~ - J DISTRICT N0. GROUP I CLASS 1,AAP PROCESSED BY BK CONTRACTOR f ., iu, i f ""'_i "Y !i . ADDRESS ! 0 1 v-{,.- L'.._ i;.r ,,, ..� j. .. CONNECTION DATA f', CITY TEL. NO. STATION DEPTH STATE LIC - f MANHOLE REFERENCE UPPER LICENSE NO. _rt CLASS _ 'r ':n 7 ,.. NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION EENGTH FROM USE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.C. UBLIC SEWER @ $5.00 P.C.NO. � SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. ti HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. ' PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR _ .f••1 AFFIDAVIT wAIYErt Ens EMEXi RECORD. INSTR. NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD UJ EXTN..CESSPOOL.DRVWELL.MANHOLE @ $5.00 7.I HWY.OR ST.WIDENING ALTER.REPAIR OR ABANDON HOUSE E"- SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT - , PERMIT NO. INDUSTRIAL ci WASTE APPROVAL d...:.-.- -_ '-T.rdJ 0/ I Lf_ OWNERS PERMIT t ' 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE . >" - F- I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING READ CONDITIONS BELOW TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19— THIS FORM WHEN PROPERLY MACHINE VALI- OWNER OR OWNERS AGENT DATED BELOW IS A PERMIT TO DO THE WORK ADDRESS DESCRIBED. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION Permittee is hereby authorized to install the work AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY as shown, in accordance with provisions of Ordin- WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. once No. 2269 and related Ordinances. E - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR This permit becomes null and void if work is not com- LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF menced within 60 days from date of issuance, T CALIFORNIA OR H-AT I AM THE LEGAL OWNER OF. AND INTEND TO Or if work is suspended at any time during con- RESIDE IN, THEA VE DESCRIBED RESIDE(,JTIAL PROPERTY. SIGNATURE struction for a period of 120 days, or if any work is OF PERMrTTEE i•'-,'',-;""� at., - s - &3a done on the said building or structure in violation of the County Ordinances or State laws governing same. VALIDATION JACK R. ALLEN CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER