HomeMy Public PortalAbout4943 BALDWIN AVE_Sewer__ (2) TEMPLE CITY
6A642D 62
7APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE County Enggmeer ADDRESS
WILLIAM A JENSEN Sup t of Buildmg
LOCALITY Tem C a Cl
NEAREST
FOR APPLICANT TO FILL IN CROSS Sr T,ower Azusa
LEGAL
DESCRIPTION LOT NO �` OWNER Lun-Dee Investment Co.
MAIL
BLOCK aTRACT ADDRESS 11706 Ramona Bi.
'f �yrt
NO
SIZE OF LOT NOW OON LOTS CITY El Monte TEL NO
USE OF
BUILDINGS 'y� DISTRICT NO GR1OUP MAP PROCESSED BY
CONTRACTOR
Square a Deal Sewer �'
ADDRESS 29 33 Mayyaon Rd. CONNECTION DATA
CITY El Monte [�(T�EL NO GI 4-2020 STATION 'O+ O' . C DEPTH I� /
REGISTRATION NO 12$$ 0 ❑ COUNTY STATE MANHOLE REFERENCE 7� 1J /-{ �"� LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM R /
HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L ! O.
PUBLIC SEWER CSB E5 00 O
SEPTIC TANK SEEPAGE PIT OR - OS P C NO V
PITS AND/OR DRAINFIELD @ $1000
CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO 9- O
PRIVATE DISPOSAL SYSTEM @ E3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAIVER EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ S300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ E5 00 HWY OR ST WIDENING
ALTER REPAIR OR ABANDON HOUSE _
SEWER OR DISPOSAL SYSTEM @ E3 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNER$ PERMIT $ 2 00 CHARGES
AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO COV NECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE" INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_ A . Y
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ CONNECT ADDITIONAL 1
ADDRESS 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 15 CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL Cl
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGI TERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNT AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER O AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED RESIDENTIA PRO RTY ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE
BACKFILL SEPTIC TANKS El ❑
SEEP PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A WOOD
cK M o CASH SUPERVISING MECHANICAL ENGINEER
t~riU 2 / 78"113 RPR 1 :I. CD 7,C)0