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Home My Public Portal About4938 BALDWIN AVE_Sewer__ (2) So $64 of N. 344.54 of TEMPLE CITY Lot 49 1 76A64 2D 0 63 APPLICATION FOR PERMIT A64lJ COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS 8 N Baldwin Ave. WILLIAM A JENSEN Sup t of Building LOCAL TY NEAREST FOR APPLICANT TO FILL IN CROSS ST Roap ,EGAL DESCRIPTION LOT NO OWNER Joe Adashek BLOCK TRACTS. J. Baldwin Add. MAIL ADDRESS 221 Palm Circle NO OF BLDGS SIZE OF LOT NOW ON LOT CITY Arcadia TEL NO USE OF DISTRICT NO GROUP MAP PROCESSED Y BUILDINGS Res* �f f 6 BK PG L CONTRACTOr�j uare Deal Sewer ,Service A1 � -�_ � ADDRESS 2933 Maxson Rd. CkIQ CONNECTION DATA CITY El MonteTEL NO 41k4-2020 ION , DEPTH / ❑ STATE MANHOLE REFERENCE REGISTRATION NO128A ❑ COUNTY LOWER NO DESCRIPTION OF W 4 FEE YPE O CO I N LENGTH ROM r HOUSE SEWER CONNECTING TO M L TO L '"Z,• PUBLIC SEWER @ 55 00 00 P C NO d SEPTIC TANK SEEPAGE PIT OR CO IMP NOJOB NO O PITS AND/OR DRAINFIELD @ 51000 U HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ S3 00 , CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVE[ [ASEM[N7 RECORD INSTR NO DATE V WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD W EXTN CESSPOOL DRYWELL MANHOLE @ $500 h ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ 53 00 STATE ENCROACHMENT PERMIT NO �. INDUSTRIAL WASTE APPROVA CHARGES OWNER S PERMIT E 2 Oo AUTHORIZATION I TOTAL FEE 00 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 PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) N� I HEREBY ACKNOWLEDGE THAT 1 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 A PLUMBING AND SEWERS CESSPOOL ElDRYW ELL F-1 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 C� CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIA PROPERTY ABANDON HOUSE SEWER SIGNATURE �Y/�I BACKFILL SEPTIC TANKS ❑ OF PERMITTEE / ,Q SEEP PIT(5) [I CESSPOOLS C3, & VALIDATION ROBERT A woos SUPERVISING MECHANICAL ENGINEER CK M O CASH 1` ,02 3 5 7:� IAY27 1 0 D 7 00 $6t of N. 344.5t of Lot 49 TEMPLE CITY 10 63 76A642D APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FAD ING JOHN A LAMBIE County Engineer SSWILLIAM A JENSEN Sup t of Building Tem le CIt TYSTFOR APPLICANT TO FILL IN ROST a Rosa LEGAL DESCRIPTION LOT NO OWNER Joe Ariashak MAI f� L BLOCK TRACTEf . J. Baldwin Add O ADDRESS222 Palm C3.rcle7l NO OF BLDGS SIZE OF LOT NOW ON LOT CITY Arcadia TEL NO USE OF BUILDINGS es DISTRICT NO GROUP MAP PROCESSED BY _ BK PG A A CONTRACTOR �► '!/7C/`}C/ i quare ADDRESS29,13 axson Rd. CONNECTION DATA CITY TEL NO T ION DEPTH STATE REGISTRATION NO Q COUNTY MANHOLE REFERENCE ' ` LOWER NO DESCRIPTION OF WORK FEE7 PE OF IN T N LENGT FROM HOUSE SEWER CONNECTING TO Y P M L T P L PUBLIC SEWER SS 00 PC NO O SEPTIC TANK SEEPAGE PIT OR CO IMP NO J013 NO PITS AND/OR DRAINFIELD @ $1000 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT walY[R EA5[M EHT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD l!J EXTN CESSPOOL ORYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO 1 Saddle O INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSP i�TOR 5 SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANKSEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAI INFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY 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 THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PRO RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER tCO2358n MAY 2711 0 2500Nco