HomeMy Public PortalAbout5220 BARELA AVE_Sewer__ PIP
76A6 42D
CE 808(REV.6/781
APPLICATION FOR PERMIT
OS
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP MAP [, PTROESED BY
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Y
BUILDING
ADORE S 5220 Barela Ave. -
S
LOCALITY
Temple Cit CONNECTION DAT
NEAREST Rosa STATION DEPTH
CROSS ST. UPPER
MANHOLE REFERENCE
OWNER Cardella LOWER
TYPE OF CONNECTION LENGTH FROM
MAIL Y. CURB P,L. M.L.TO P.L.
Ave,ADDRESS 220 B rela A
R f� P.C.NO.
CITY Temple CitYEL.NO. 285-38CO.IMP.NO.07 JOB NO.
LEGAL TRUNK PERMIT NO. ROAD PERMIT NO.
DESCRIPTION LOT NO,
AFFIDAVIT I WAIVER I EASEMENT RECORD,INST R.NO. DATE
BLOCK TRACT
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS STATE ENCROACHMENT
PERMIT NO.
CONTRACTOR Universal Plumbing INDUSTRIAL
C] WASTE APPROVAL
ADDRESS
Lee Ave. CHARGES
So.
CITY So. l'1 MontBEL.NO. 575-3460 CONNECTION CHARGE FEE
LSTATE L
ICENSE NO. 31601" CLASS C36 & S 20 REIMBURSEMENT FEE
d
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE u
HOUSE SEWER CONNECTING TO Ilm
PUBLIC SEWER C
SEPTIC TANK.SEEPAGE PIT OR NEW HOUSE SEWER ''
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL {{{Y9W
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM d
CONNECT ADDITIONAL BLDG.OR SEPTIC TANK,SEEP.PIT(S) IIA
WORK TO HOUSE SEWER AND/OR DRAINFIELD f-.
OVERFLOW SEEPAGE PIT.DRAINFIELD CESSPOOL ❑ ORYWELL❑
EXTN..CESSPOOL.DRYWELL.MANHOLE
ALTER,REPAIR OR ABANDON HOUSE \ ALTER.REPAIR,SEWER OR -
SEWER OR DSPOSAL SYSTEM `!� SEWAGE DISPOSAL SYSTEM
If p
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS❑
SEEP,PIT(S)❑ CESSPOOLS❑
OWNER'S Permit 5
AUTHORIZATION FTOTAL FEE -
VALIDATION
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- ��' G /1.� `�!/•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING /. -7, � 5�5 3./5 R
TO THE PUBLIC SEWER, l.C"/
SIGNEDTHIS DAY OF_ 19— # • • • 10
OWNEROR
OWNERS AGENT
ADDRESS
21� • O O
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION • • • 1 4,006
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. 07. 18-79
I HEREBY CERTIFY THAT rAM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED B 05 ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM LEGAL OWNER OF.AND INTEND TO RE-
SIDE IN.THE ABOVE DES ED RESIDEN AL PROPE RT V.
SIGNATURE "
OF PERMITTEE
r.
�642D
CE8081REV.6i781
Os APPLICATION FOR PERMIT
SEWER' -* SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP
BK SPG MAP PROCESSED BV
FDE..,R,PT,.N
G 2 l�1 y V49,
S -�! AH fY! -
��yy�� 9q� / +ty CONNECTION DATA
Y jp�,1! �+p
T f,� ¢swr. STATION DEPTH
T. is ROM
`',��I� UPPER
`�pi.' MANHOLE REFERENCE-
LOWER
TYPE OF CONNECTION LENGTH FROM
S 5��I y Y. CURBK P.L. M.L.TO PL.
:.)'S}G„JQQ& "`VS• �}[� P.C.NO.
br.it ✓fEL.NO. -""�` CO.IMP.NO. JOB NO.
L TRUNK PERMIT NO. ROAD PERMIT NO.
PTION LOTNO.
AFFIDAVIT I WAIVER EASEMENT RECORD,INSTR,NO, DATE
BLOCK TRACT
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT HWY.OR ST.WIDENING
USE OF
BUILDINGS y `7 • STATE ENCROACHMENT
TT l +lamf'Y� PERMIT NO.
♦' �yi'>g INDUSTRIAL
CONTRACTO WASTE APPROVAL
,rtctlt you !,va•
ADDRESS CHARGES
=-6I _. "�• -ti/Yror. d.�'. CONNECTION CHARGE FEE
?�
CITY ''' • - E �pL.NO. I a'
STATE :y'p�'y LIG. REIMBURSEMENT FEE O
LICENSE NO. CLASS
uj
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE J_
HOUSE SEWER CONNECTING TO LL.
PUBLIC SEWER NEW HOUSE SEWER
SEPTIC TANK.SEEPAGE PITOR (�
PITS AND/OR DRAINFIE LD
CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
SEPTIC TANK,SEEP,PITIS) O
CONNECT ADDITIONAL BLDG,OR AND/OR DRAINFIE LD 0.
G
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL -: DRYWELL:1 W
EXTN..CESSPOOL.DRYWELL.MANHOLE F
ALTER.REPAIR OR ABANDON HOUSE ALTER.REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
OWNER'S
Permit $ SEEP PIT(S) CESSPOOLS
AUTHORIZATION TOTAL FEE VALIDATION
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TOTHE PUBLIC SEWER.
SIGNED THIS DAY OF 19_
OWNER OR _ ¢ • +' �
OWNERS AGENT
y
ADDRESS ..
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - • • '� ��e
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY 'Stlfa�'.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. -y
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.AND INTENDTO RE-
SIDE IN.THE AE30VE DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERMITTEE --