HomeMy Public PortalAbout9022 JAYLEE DR_Sewer_4/29/1968_2640 sewer connection City Of Temple City # 2640
6A642-62
7 D APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS 9022. Jal lee%
WILLIAM A. JENSEN, Sup't of Building
LOCALITY Temple yityd
NEAREST Sultana .
FK
OR APPLICANT TO FILL IN CROSS ST.
AL
DESCRIPTION LOT NO. OWNER G• F• Wandro
MAIL
TRACT ADDRESS 9022 a lee
OT NOWNO. OON LOTS CITY em le Ci TEL. N0.287 2148
DISTRICT NO. ROUP MAP PROCESSED BY
p� 7�OR J & D Plumbing C+o• / /t 414 So. San Ga�byriel Blvd CO ECTION DATA
an GabrielEL. NO. At. 70579 STATION C- DEPTH
STATE
REGISTRATION NO.
243896 [1COUNTY MANHOLE REFERENCE UPPER
NO. DESCRIPTION OF WORK FEETYPE OF CON NECTI LENGTH,
FRO �.
HOUSE SEWER CONNECTING TO Y. CURBFp
M.L.TO P.L. �� d
1 PUBLIC SEWER @ $5.00 _ O
SEPTIC TANK,SEEPAGE PIT OR � {{ (�
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. /�J JOB NO. V
1139
HOUSE SEWER CONNECTING TO
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EIIEMENT RECORD. INSTR,NO. DATE
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD d`
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 h
ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT s 2 00 CHARGES
AUTHORIZATION TOTAL FEE /1'7 00 CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLISEWER. 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.PITS)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY ,
WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY 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 IAM THE LEGAL OWNER OF, AND END TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROjERT .� ABANDON HOUSE SEWER Of
SIGNATURE
OF PERMITTEE J & D Plb . A KFILL SEPTIC TANKS
T [D ❑ `Q
517 E PIS) CESSPOO ❑ r
VAI ATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
Lktj,o 4 4 6 5 APR 2 9 1 0 D 7.0 0