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Home My Public Portal About9543 BLACKLEY ST_Sewer__ TEMPLE CITY CESO 3-62 APPLICATION FOR PERMIT 76A6 ZD COUNTY OF-LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS951+3 ^T .—Blackley -St . WILLIAM A. JENSEN, Sup't of Building LOCALITY TempleCity NEAREST FOR APPLICANT TO FILL IN CRD55 ST LEGAL DESCRIPTION LOT NO. 9 OWNER Eugene Rl eiro Mission View MAIL BLOCK TRACT MR ADDRESS 1700 Garfield NO- OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO. USE OF BUILDINGS DISTRICT NO I GROUP MAP PROCES BY � BK PG CONTRACTORre 6 , ADDRESS 2933 CO NECTION DATA CITY El Monte TEL NO GI —2020 IT/T.-N 1/ TION// 5 DEPTH/„l�(�/ ' ❑ STATE MANHOLE REFERE CE REGISTRATION NO 128870 ❑ COUNTY LOWER NO DESCRIPTION OF WORK FEE ypE OF ON E TION LENGTH ROM HOUSE SEWER CONNECTING TO Y .L M PUBLIC SEWER @ $5 00 PC NO SEPTIC TANK,SEEPAGE PIT OR JOB NO V PITS AND/OR DRAINFIELD @ $1000 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT PRI VATE DISPOSAL SYSTEM @ $300 CONN ECT ADDITIONAL BL DG OR AFFIDAVIT I WAIVER E1SEM11T RECORD INSTR NO DATE 1r40��!-' WORK TO HOUSE SEWER @ S300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN.CESSPOOL DRYWELL.MANHOLE @ $500 HWY OR ST WIDENING ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $300 STATE E ROACHMENT PERMIT IN IAL W P � OWNERS PERMIT $ CHARGES AUTHORIZATION I TOTAL FEECONNECTION CHARGE FEE DDL I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO 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 OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY 'ND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, ND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DES C IBED RESIDENTIAL ROPE Ra'PS .BANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS [:]OF PERM1'ITEE�� p�:_ SEEP.PIT(s) ❑ CESSPOOLS ❑ !'^ VALIDATION ROBERT A. WOOD �K. M O. CASH SUPERVISING MECHANICAL ENGINEER L1 ii 7 6 2 3:I'D j'JL 2 2 1 1. D r 5.C-,0 N n' TEMPLE CITY CEBOB 2D-62 3APPLICATION FOR PERMIT 76A84t1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL EPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST JOHN A. LAMBIE, County Engineer 9543 E_ Blackley -St. WILLIAM A. JENSEN, Sup't of Building /1 7Temple Cit Cloverl FO APPLICANT TO FILL IN LEGAL _5 9 '�7 DESCRIPTION •L T O OWNER Eugene Ribeiro MAIL BLOCK TRACT Mi ssion ViewADDRESS NO OF BLDGS - SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS Ree DISTRICT NO GROUP MAP PROCE ED BY BKFG CONTRACTOR SqUare al Sewer Service , p� ADDRESS • CONNECTION DATA CITY E1 Monte TEL NOGI 4-2020 TION DEPTH I( STATE REGISTRATION NO H COUNTY MANHOLE REFERENCE LOWER NO DESCRIPTION K FEE TYPE F O NECTION LENVH FROM HOUSE SEWER CONNECTING TO o0 P L ML TO P L O , PUBLIC SEWER @ $S 00 SEPTIC TANK SEEPAGE PIT OR P C NO V PITS AND/OR DRAINFIELD @ $1000 JOB NO JJJ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT / PRIVATE DISPOSAL SYSTEM @ $3 00 / CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVEN EASEMENT RECORD INSTR N DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT,DRAINFIELD (� EXTN CE SS POOL,DRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING fes+ SEWER OR DISPOSAL SYSTEM @ S3 00 STATE EN OACHMENT PERMIT N IND U L WAS A V OWNERS PERMIT, $ 2 00 CH AUTHORIZATION I TOTAL FEE 100 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATU REs SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER y/W65 OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD - AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWEL•L ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUN Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER F, ND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DE CRI ED RESIDENT L TOPE RTY ABANDON HOUSE SEWER -- SIGNATURE BACKFILL SEPTIC TANKS ❑ - O F PERMITTE ESEEP PITS)) El CESSPOOLS ❑ U.KCAALMATION ROBERT A. WOOD SH SUPERVISING MECHANICAL ENGINEER U.K M 0 CASH 7 8 2 1'Q JJL 22 1 }I o 7.0 0•- .