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Home My Public Portal About9541 BLACKLEY ST_Sewer__ TEMPLE CITY CE8083-6� D APPLICATION FOR PERMIT CE808 76A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPA�TMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F.S JO{IIQ A. LAMBIE, County Engineer 9541 E. Blackley St. WI AM A. JENSEN, Supt of Building FOR PLICANT TO FILL IN LEGAL DESCRIPTION LOT NOS, OWNER MAIL BLOCK TRACT Mi ssion ViewADDRESS NO OF BLDGS 1700 Garrield SIZE OF LOT NOW ON LOT 3 CITY AlhambraTEL NO USE OF K PG BUILDINGS Res• DISTRICT NO GROUP MAP PROC ED BY B CONTRACTORSquare Deal Sewer Serviceox r, ADDRESSCONNECTION DATA 2933 Maxson Rd. CITY El Monte TEL NO GI -2020 ATION DEPTH- STATE MANHOLE REFERENCE/ REGISTRATION NO COUNTYAe,7. LOWER NO DESCRIPTION OF WORK FEETYPE OF CO ON LEN FROM HOUSE SEWER CONNECTING TO Y P L M L TO P PUBLIC SEWER @ $5 00r SEPTIC TANK,SEEPAGE PIT OR P C NO AQ- PITS AND/OR DRAINFIELD ' @ $1000 CO .108 NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N PRIVATE DISPOSAL SYSTEM I @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR ANO AT WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WI ENING SEWER OR DISPOSAL SYSTEM @ S300 STATE ENCRO MENT 2 OO PERMIT NO addleINDUST ;K O OWRCHARGES NES PERMIT $ AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER 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,PIT(5) II HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH• ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF ND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBE ESIDENTIAL OP RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ r ALIDATION ROBERT A. WOOD (SK M O CASH SUPERVISING MECHANICAL ENGINEER L 6c 7 8 8"':") JUL 2 2 1 1 a 2 5.0 0- Z C 6 yjd lG wle'1 �(l ,Z��✓��'.� ��d'! TEMPLE CITY 76A642-62D APPLICATION FOR PERMIT 6A842 CO TY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPART NT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A� LAMBIE, County Engineer ADDRESS 95�1 E. 131ackley St. WILLIAM JENSEN, Supt of Building C LOCALITY Temple City NEAREST loverl FOR APP ICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER Eugene Ribeiro MAIL BLOCK TRACT ion View ADDRESS 1700 Garfield NO OF BLDGS l ' SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT N GROUP MAP PROCE D BY BUILDINGS Res. _ BK PG CONTRACTORSewer Q ADDRESS Maxs on Rd. CONNECTION ATA CITY 1 Monte TEL NO GI _2020 TION DEPTH ❑ STATE MANHOLE REFERENCE REGISTRATION NO ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF ON IF LE H FRO HOUSE SEWER CONNECTING TO Y C L M TO P L PUBLIC SEWER @ $5 00 00 SEPTIC TANK,SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ $10 00 O '�O JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N PRIVATE DISPOSAL SYSTEM @ $300 71 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVII EAIIMEMT RECORD INSTR NO ATE WORK TO HOUSE SEWER @ S300 OVERFLOWSEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWE L L,MANHOLE @ $500 HWY OR ST WI NTNG ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM $3 00 STATE EN HMEN PERMIT INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT S s 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION-CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HER NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE, INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ / OWNER OR NEW HOUSE SEWER 3/ OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(5) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND TATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND JNTEND TO DISCONNECT PLUG AND RESIDE IN, THE.ABOV DE5CR{,6ED RESIDENTIAL PROP {tTY ABANDON HOUSE SEWER SIGNATURE Tj�/ BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK M O CASH SUPERVISING MECHANICAL ENGINEER �` C7 8 1 7t JJL ?2 7 D 7.00