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Home My Public Portal About6358 BARELA AVE_Sewer__ 1 TEMPLE CITY' 78A APPLICATION FOR PERMIT CE90a s.89 8 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUDILDING JOHN A. I.ANIBIE, CountyEngineer CASSATT D. GRIFFIN, SupADRESS of Bulldmg LOCALITY e NEAREST I FOR APPLICANT TO FILL IN CROSS ST. LEGAL -i DESCRIPTION LOT N0. OWNER / MAI L BLOCK TRACT 7 ADDRESS N0.OF BLDGS. / SIZE OF LOT NOW ON LOT CITY at— TEL. NO. USE OF BUILDINGS S DISTRICT N0. GROUP BK PG MAP I PROCESSED BY CONTRACTOR � Af / /_ T&:�� ADDRESS Ly ✓l CONNECTION DATA CITY TEL.NO. STATION DEPTH STATE MANHOLE REFS EN UPPER REGISTRATION NO. COUNTY LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO - lyeir PUBLIC SEWER @ $3.00 it 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 CO.IMP. NO. B N CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. OAD P T N0. WORK TO HOUSE SEWER @ $1.00 • ALTER, N HOUSE STATE ENCROAC SEWER @ $1.00 PERMIT N0. INDUSTRI WASTE RI 4-5— VAL CHARGES OWNERS PERMIT T 2 OO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1106 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'SSIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND ASTATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBCT PLUG AND Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CTPLUGHOUSE D CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE OF VALIDATION ROBERT A. WOOD CP. Y.0. CASH SUPERVISING MECHANICAL ENGINEER `r 3 4 4 0 3.00 APPLICATION FOR PERMIT DrMON,,.O. a F�BUILDING AND QAFLTY SEWER—SEWAGE DIS POSE L q CouniT FBIMW� OHN A. LAMBIE, COUNTY ENGINEER EBSAler m Cf. EST �B+,H�ATT yD.GGRII"IIN,, SVI-T OF+8UUI�LDI7N�O LITY i OR lS.CCLiI�Al\L TO r 1LL I LEGAL DESCRIFT-19N LO NO� R f MAIL BLOCK TRACT ADDRESS X0,OF Ill-b", CITYr L. XO, SIZE OF LOT MOW DX LUT USE BUILDINGS-DDIMICT• 0. _5;7 B[ FG GZOUP YAP ' 5 vfwf / CONTRACTOR . ADDRESS r, rl CbN?M=0N DATA STATION D M GTT TEL.N0. IANHOLA REFERENCE UPOELR d STATE LOWER REGISTRATION NO. ❑ COUNTY 1. D No. DESCRIPTION OF WORK FEE HOUSE SEWER COM RCTING TO TYPE OF COMMECT16N LENGTH FROM PUBLIC SEWERto S.SO Y. CURB P.L. Y.L.TO P.L. SEPTIC TANX,SEEPAGE PIT OR PITS A11D/OR.D INFI-ELD 3.00 OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. NO-. METN.,CESSPOOL D rirELL MANHOLE40 41.06 CO, I P.M0, !OB NO HOUSE Sft CONNECTING TO - i PRIVATE DISPOSAL SYSTEM =1.00 TRUNK PERMIT NO., ROAD PERMIT NO. CONNECT ADDITIONAL QLDG.OR /� STATE ENCROACH*ENT WOR[TO HOUSSEWER S 1.00 D G PERMIT NO. Al ,REPAIR Ott AEIAN-DOk HOUSE INDUSTRIAL ' SEWER,9R DISPOSAL Y 11.00 WASTE APPROVAL C HAR G ES COXNECTION7 CHARGE FEE � OWNERS FST s 1 00 AUTORIZATION TOTAL FM REIMBUR3EMEIITF2f T� 1 HAVE AT THIS DATE A CONTRACT WITH t149 HEREIN YAl[D CON- APPEOYAIS DATE INSPECT9R'SSIGNATURE TRACTOR TO CONNECT THR ABOVE DESCRIBED EXISTING Dw'EI,LIMG TO THE PUBLIC SEWER. NEW HOUSE SEWER - SIGNED THIS RAY OF 19 CONNECT ADDITIONAL OWN£,8 O@ - BUILDIN-G OR ORI( - - QWM RQEM7 SEPTIC TANK,SEEP,PIT(0) AD RESIT AILD/OR DRAINFIELD I HEREBY AC"OWl.�DGE THAT I HAVE RD THIS APPLICATION CEBSPOOL L] DRYWELL❑ V[�,�p;EH-S'1•ATE THAT THK ABOVE 13 CORRECT A%, AGREE TO' COMPLY WITt1 ALL COUkTY' ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUNNIXG AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSEO AS REQUIRED BY LOS ANGELES COUNTY AND STATE Of ABAIIDOM HOUSE SEWER CAALIFORNI OR T T 1 All TH LEGAL O700�r D EBCRIBEb HESI DRM IAL PROPER BACKFILL SP'�IC TANKS CjlIGMATU@EEEP.PIT(f ❑ CESSPOOLSQOF PERS114TEE - JOHN A. LAMOFFE', CfOUNTY ENOIN[ER VALIDATION ROBCRT A.WOOD,C:HI[F PL.DG. INSPI�CCOR ca. ■.b. �/ _ ° :�7,'7V; s&25 4 2.00 .