HomeMy Public PortalAbout5420 BALDWIN AVE_Sewer__ C I T Y O F T E M P L E C I T Y
D
CE808 APPLICATION FOR PERMIT
eeoe a ae COUNTY OF LOS ANGELES �.
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING cj42@� Baldwin Ve•
JOHN A LAMBIE Count En neer ADDRESS
CASSA17 D GRIFFIN Sup t of Building LOCALITY Temple 1
NEAREST Olive
FOR APPLICANT TO FELL IN CROSS Sr
LEGAL a s{0 t�6 7 7�1�q
DESCRIPTION LOT NO OWNERMurray ra an Halverson
BLOCK TRACT �,, �,, , DRE MAIL 535 So. econd Street
NO OF BLDGS �s[�e ovina
ED I-
SIZE OF LOT N W ON LOT CITY TEL NO
I
BURes.
OF p gp DISTRICT NO GROUP BK MAP PG PROCESSED Y
LDING
CONTRACTORL. D. & M. Constr. Co. 5'�g'
ADDRESS 5136 No. Ble ecker St. cONNE TIN A A
CITY Baldwin Par]JYEL NO ED 8-3024 STATION 1q,05',jq DEPTH
REGISTRATION NO 113613 STATE MANHOLE EFERENCE UPP
COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 7 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TO P L
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM @ $1 00
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER REPAIR OR ABANDON
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
CON
TRACTOR TO CIONNECT THE ABOVEDATE AT DESCRIBED EXISTWITH THE IJNGAMED DWELLING APPROVALS DAJE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT NEW BUILDING OR WORK
ADDRESS SEPTICTANK SEEP PIT(S)
AND/OR DRAINFIELD
LEBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRY-WELL ❑
LL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
G AND SEWERS SEWAGE DISPOSAL SYSTEM
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
D AS REQUIRED BY LOS ANGELS COUNTY AND STATE OF ABANDON HOUSE SEWER
NIA OR THAT 1 AM THE OWNER OF THE ABOVE
ED RESIDENTI OPE BACKFILL SEPTIC TANKS ❑
SEEP PIT(S) ❑ CESSPOOLS ❑RE MITT
OF ALIDATION ROBERT A WOOD
CK m o CASH SUPERVISING MECHANICAL ENGINEER
LIjU0S 8 6 9\:4:30 NOV 1 J D 5 CF v