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Home My Public Portal About6273 ROSEMEAD BLVD_Sewer__ 6A 6422DD 7APPLICATION FOR PERMIT 76,A 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 6'? 7-3 S�/9JPRY COLEMAN W. JENKINS. SLIP'T. OF BUILDING LOCALITYOR APPLICANT TO FILL IN NEAREST(PRINT OR TYPE ONLY) cRoss 57.LEGALDESCRIPTION LOT NO. OWNERMAIL BLOCK TRACT (J ADDRESS It 6NO. OF 'BLDGS, t� ��SIZE OF LO7 NOW ON LOT CITY TEL. NO. USE OFBUILDINGS �4� DISTRI/C////`T NO. GROUP CLASS BXMAP CONTRACTOR � ES5 2r,-2 � VADDRESS �'y'qo � C/ Sp; CONNE TION DATACITY �. TEL. NO. 's-k3 / STATION DEPTH STATE LIC LICENSE NO.; CLASS MANHOLE REFERENCE � e O LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P. PUBLIC SEWER @ $5.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD @ $10.00 CO. IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. a PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER I'EASEMENT RECORD.INSTR.NO. DATE V WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD Q� ErADDRES XT��N..CESSPOOL.DRYWELL.MANHOLE @ $5.00 O !'7R.ABANDON HOUSE .>) HWY.OR ST.WIDENING 0 WER�YGAO&Wt SYSTEM @ $3.00 1 Lu STATE ENCROACHMENT t V PERMIT NO. - 0- INDUSTRIAL Ny WASTE APPROVAL S CHAR ES NERS PERMIT $ i 00 CONNECTION CHARGE FEE ORIZATION TOTAL FEE "57 ft AT THIS DATE A CONTRA W H THE H REI AME D CON. REIMBURSEMENT FEE TO CONNECT ABO E D S RIBED IS IN.. DWELLING' PUBLIC SEWE . APPROVALS DATE INSPECTOR'S SIGNATURE THIS DA OF RA NEW HOUSE SEWER AGENT CONNECT ADDITIONAL � BUILDING OR WORK SEPTIC TANK.SEEP.PIT IS) BY ACKNOWLEDGE THAT 1 HAVE SAD THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT,AND AGREE TO COMPLY WITH ALL COUNTY ORDIN CES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY TH T I M E Y R IS R D AND/OR ALTER,REPAIR.SEWER OR LICE117 NSED A5 REQUIRE BY L S NGLEIS OU AN STATE OF SEWAGE DISPOSAL SYSTEM 42 CALIFORNIA OR THAT AM TH L GA�. O ER/Of, AN INTEND TO RESIDE IN, THE Z80DESCR BE ENT( R ERTY. DISCONNECT PLUG AND •%% ABANDON HOUSE SEWER / SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP,PIT(5) ❑ CESSPOOLS ❑ ALM.0. CASH N JACK R. ALLEN } SUPERVISING MECHANICAL ENGINEER CK. M.O. A^_ 8 9 0 51:1- IFEO-l26 1 -0 5.00- S" CE808 10-63 76A6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDI JOHN A. LAMBIE. County Engineer ADDRE WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. L1GAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT 76 ADDRESS NO, OF BLDGS. f B U'L 0 ING A D RE SS C A L TY ST C7 LO NE:ARE RO S T SIZE OF LOT NOW ON LOT CITY T USE 0 IF GS DISTRICT 110. GROUP BUIL N MAP PR.CE PG CONTRACTOR ADDRESS CORNECTION DATA -EPT. 7 CJT" Ne STATION -ow LLI`_5TATE MANHOLE REFERENCE REGISTRATION NO. 0 COUNTY- I 11 5 9-1 NO. DESCRIPT10N OF WORK FEE TYPE OF CONNECTIO v LFNG rl FRO:z4:�—/ m '? HOUSE SEWER CONNECTING To Y. CURB L 0 P.L. PUBLIC SEWER @ $5.00 _116710-0 / _ 2:�_L� P.C.NO. SEPTIC TA 07 JOB NO. 0 NK.SEEPAGE PIT OR CO.IMP.NO. PITS AND/OR DRAINFIELD @ 510�00 HOU S E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT � WAIVII IAII.�IIT RECORD, INSTR.NO. DA 0 TE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.W I DEN I NG SEWER OR DISPOSAL SYSTEM @ $3.00 z STATE ENCROACHMENT PERMIT NO, INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE CHARGES AUTHORIZATIONI TOTAL FEE 4;;0 I HAVE AT THIS DATE A CONTRACT W I TH THE HEREIN N04MEO CON. REIMBURSEMENT FEE TRACTOR T 0 ONNECT THE ABOVE DESCRIBED EXISTING DWELLING To THE PUBLCIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS—DAY OF— 19 OWNER R 11- NEW HOUSE SEWER OWjqERS 0_r - OAGENT c,=T:;A 2,-, CONNECT ADDITIONAL ADDRESS ci C�,t g Ly 0j,. BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) I EREBY ACKNOWLEDGE THAT I HAVIf READ THIS APPLICATION AND/OR DRAINFIRLD ANDHSTATE THAT THE ABOVE IS CORREET AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS, CESSPOOL [I DRYWELL 0 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR L IC ENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIIFORNIA OR THAT El AM TH E LEGALSOWNER OF, AND INTEND TO DISCONNECT PLUG AN RES DIE IN, THE ABOV DESCRIBED RE ID E NTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE I-BACKFILL SEPTIC TAN 'S OF PERMITTEE IX-Irc;tz -1 SEEP,PIT(S) [_ CESSPOOLIv VALIDATI0p---_-\ ROBERT A. WOOD CK. M.0. SUPERVISING MECHANICAL ENGINEER L 7 6 9 7 JAN 2 6 1 0 A TO 0- s Y 2/70 76A 642D APPLICATION FOR PERMIT 76A 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST �7 JOHN A. LAMBIE. COUNTY ENGINEER / 3 Qs� e^ COLEMAN W. JENKINS. SUPT. OF BUILDING FOR APPLICANT TO FILL IN T. (PRINT OR TYPE ONLY) LEGAL .?^'/ , DESCRIPTION LOT NO. OWNER ( (� L MAIL BLOCK TRACT d ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. _SrOF ' BUILDINGS DISTRICT NO. GROUP CLASS MAPr24 PROCESSED BY op BK PG CONTRACTOR �� ! It O � !Y ADDRESS r " J .j �� (r' C Al '�` v A �� Na CONNECTION DATA CITY " A TEL. NO. STATION DEPTH * ATEL'Cy� ( /` UPPER ITC ENSE NO. 3 _ CLASS L ~ rJ • MANHOLE REFERENCE NO. -DESCRIPTION OF WORK FEE TYPE OF CONNECTION ENGTH F OM USE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. UBLIC SEWER Q $5.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD Q $10.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 CL CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIY[■ EASEMENT RECORD.INSTR.NO. DATE 4> WORK TO HOUSE SEWER $3.00 lJ OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.,CESSPOOL.DRYWELL.MA NH OLE Q $5.00 04 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00 F- STATE ENCROACHMENT PERMIT NO. ) U.) C _+_ -INDUSTRIAL f/D WASTE APPROVAL CH RGES OWNERS PERMIT $ 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF _19- OWNER 9_OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PITS) - 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 ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DESCRIBED RESID%p TIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PER MfTTEE �" SEEP.PITS) ❑ CESSPOOLS ❑ V IDATION JACK R. ALLEN CASH SUPERVISING MECHANICAL ENGINEER 3 1