HomeMy Public PortalAbout4846 AGNES AVE_Sewer_7/25/1975_CONNECT ADTL BATHROOM TO HOUSE SEWER 76A64V-CE806-1071 APPLICATION FOR RMIT
COUNTY OF LOS ANGELES SEWER AGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 4g46 Agnes L--
ADDRESS
LOCALITY Temple City
NEAREST
FOR APPLICANT TO FILL IN CROSS BT
LEGAL
DESCRIPTION LOT NO OWNER Rosemead Const
* (john Durner
MA IBLOCK TR CT ADDRESS 2020 Barnett W
NO SIZE OF LOT NOW
OON LOTS CITY A [MEL NO 225-3633
USE OF DISTRICT NO GROUP MAP SSED BY
BUILDINGS
BK p
CONTRACTOR Owen Bros. Plumbing,Inc. "1�d � - 7S
/7�R
ADDRESS �•••/ •Y CONNECTION DATA !/"''
wim
CITYEl me TEL NO —0078 STATION DEPTH
STATEUPPER
-1120 MANHOLE REF NCE
IS TAT.
LICENSE NO 231 741 CLASS LIC �3 LOWER
NO I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB I P L ML TOPIL
PUBLIC SEWER ! $7 00 PC NO
SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO
PITS AND/OR DRAINFIELD ! $1000
HOUSE SEWER CONNECTING TO a
PRIVATE DISPOSAL SYSTEM ! $300 TRUNK PERMIT NO ROAD PERMIT NO O
CONNECT ADDITIONAL BLS® GR.y ,` AFFIDAVIT w RECORD INS NO DATE V
WORK TO HOUSE SEWER �.y(.� 0 $300 O v
OVERFLOW SEEP GE PIT DRAINFIELD OC
EXTN CESSPOOL DRYWELL ! $500
ALTER REPAIR OR ABANDON HOUSE 0
HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM ! S300 STATE ENCROACHMENT W
MANHOLE ! $7 00 PERMIT NO OL
INDUSTRIAL N
WASTE APPROVAL
OWNER S PERMIT $ 3 00 CHARGES
CONNECTION CH RGE FEE
AUTHORIZATION TOTAL FEE Ol)
HAVEAT TH S D TE CONTRACT WITH THE HERE N N MED CON REIMBURSEMENT FEE
T C O TO CoVNECT THE BOVE 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 � C
ADDRESS BUILDING OR WORK 7��
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK SEEP P T(S)
NO STATE THAT THE BOVE IS CORRECT AND AGREE TO COMPLY ND/OR DRAINFIELD
W TH LL COUNTY O D NANCES AND STATE LAWS REGULATING
LU MIS
NG AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HE EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REOU RED Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM + r .4�/✓
CALIFORNIA OR TH I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN THE A OV ISED RESID;PXJAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTI S ❑
O PERMITTEE SEEP PIT(S) CES POOLS ❑
1 1
VALIDATION CK M O CASH
667;nJU 51 0 D 60 ®l�