The URL can be used to link to this page

Home My Public Portal About9673 BLACKLEY ST_Sewer__ ` - Ilk TEMPLE CITY -62 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENS&, Supt of Building LOCALITY NEAREST O-ftRyla FOR APPLICANT( TO/�FIILL IN CRF. LEGAL �I'__6`1/' �.1.��1 ''Q kley DESCRIPTION LOT NO 1 3 OWNER E a'ree W7 { %) MDAIL Blackley BLOCK TRACT YA.AV/ ADRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITYTeili le CityTEL. NO. USE OF BUILDINGS Ree• DISTRICT NO GROUP MAP PRO ESS BY /']) BK PG CONTRACTOR Square Deal Sewer SerVlc ADDRESS2933{. axson Rale , C��ttNNECTION ODATA CITY El MOn'te TEL NOMI 4-2020 S ION �U ' DEPTH ❑ STATE REGISTRATION NO 1 0 [I COUNTY REFERENCE I COUNTY LOWER NO DESCRIPTION OF WORK FEE YPE O O IpN LENGTH FR HOUSE SEWER CONNECTING TO P M.L TO P.L PUBLIC SEWER @ $5 00 o SEPTIC TANK,SEEPAGE PIT OR P C.NO. PITS AND DRAINFIELD @ $10.00 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO09 PRIVATE DISPOSAL SYSTEM 0 $300 TRUNK PERMIT NO' ROAD PERMIT NO. CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO, DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL.DRYWELL MANHOLE @ $5 00 ALTER.REPAIR OR ABANDON HOUSE HWV OR ST WIDENING 465 SEWER OR DISPOSAL SYSTEM @ $3 00 1 STATE ENCROACHMENT 1 Saddle 25 00 PERMIT NO INDUSTRIAL WASTE APPROVA OWNERARGESS PERMIT S AUTHORIZATION TOTAL FEE 00 CO NECTION CHAR E FEE IHAVE 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 9_OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) 1 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 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER , AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENT PRO ERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CASH SUPERVISING MECHANICAL ENGINEER CK M O l.jC065091- NOV 51 1 D 2500 v TEMP66 ,&. CITY CE8062 8-50 APPLICATION t°'OR PERMIT COUNTY OF LOS ANGELES i SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION UILDING MRESS CLOJOHN A. LAIE, CountF Engsneer DMB. GRIFFIN, Supt of Building LOCALITY EAREST FOR APPLICANT TO FILL IN Ji Ross srLEAL . DESCRIPTION LOT Noj67, , 2c; �j BLOCKr-�^^�-TRACT l G %�+' 11 DRESSr / /� d/ NO.OF BLDGS. 9 J SIZE OF LOT A NOW ON LOT ITY EL. N0. as r �J USE DDIST RICT NO. ROUP MAP Z BY BUILDINGS BK PG' I ,_,_ t Z7 CONTRACTft ADDRESS CONNECTION DATA CITY TEL,N0. ST TION DEPTH STATE yA HOLE REF CE UPPER REGISTRATION NO. OUNTY I LOWER NO. 1 DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 1 TYPE OF CONNECTION GTH FROM SEPTIC TANK, PITS AND/OR DRAINFIELDT OR @ $3.00 T. CURB P.L. L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD - EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO .11;t .1OB C.N0. - PRIVATE DISPOSAL SYSTEM @ $1.00 C .IMP. NO. N0. CONNECT ADDITIONAL BLDG.OR T UNK PERMIT NO. ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1 00 SEWER OR DISPOSALABANDON SYSTEM HOUSE @ $1 00 PERMI ENCROACHMENT PERMIT N0. 11,4DUSTRIAL WASTE APPROVAL -CHARGES, OWNER'S PERNIIT $ 2 00 NNECTION CHARGE FEE -� l AUTHORIZATION TOTAL FEE IMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. ` SIGNED THIS DAY OF 19_ _AEW HOUSE SEWER OWNER OR 'CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ "* WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF "ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE .BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDENTI PROPERTY. SEEP. PITS El CESSPOOLS El ' SIGNATURE � - S OF PERMITTEE ®r VALIDATION- ROBERT A. WOOD CK. M.0. CABII J SUPERVISING MECHANICAL ENGINEER � Q 6 5,0 3 NOV 58 1 D 18 0.0 0 r j . 1 i ti TEMPLE CITY -61 76A6423-61 APPLICATION FOR PERMIT 76A 642 COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREST LDING 6 E Blackley JOHN A, LAMBIE, County Engineer RESSWILLIAM A. JENSEN. Sup't of Building ALITY em•le Citi Barela FOR APPLICANT TO FILL IN SS ST. LEGAL DESCRIPTION LOT NO.E. 60t O 12& 13 OWNERRE Marcelus BLOCK TRACT Z./a MAIL NO.OF ADDRESS !9623 131-acklAY SIZE OF LOT NOW ON LOTS Z CITY Tpyn 1 A r,it.VTEL. NO USOF �I BUE DINGS Res. DISTRICT N0. GROUP MAPPROC SSED BY BK P CONTRACTOR SqUare DealSewer Service ADDRESS 2933 Maxson Rd. CONNECTIO DATA CITY TEL NO. GI +2020 5 ON L9 a DEPTH STATE MANHOLE REF RENCE / REGISTRATION NO. ® COUNTY No. I DESCRIPTIO FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 PE SEPTIC TANK,SEEPAGE PIT OR LENGTH FROM -PI TS AND/OR DRAINFIELD @ 33.00 N.L.TO P.L. l ' OVERFLOW SEEPAGE PIT,DRAINFIELD >_ EXTN..CESSPOOL.DRYWELL @ $2.00 CL HOUSE SEWER CONNECTING TO �?/�, .�'�IrC.N0. 0 PRIVATE DISPOSAL SYSTEM @ $t.00 CO.IMP. N0. f e'er/ JOB N0. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. WORK TO HOUSE SEWER @ $1.00 ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT O 0 SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. t' INDUSTRIAL fZ W TE 99875 H RGES OWMR'S PERMIT $ 2 OO ONNECTION CHARGE F .*'�' AUTHORIZATION 1 TOTAL FEE 1 7, 00 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'S SIGNATURE TO THE PUBLIC SEWER. /J SIGNED THIS DAY_ 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADORES SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD t HEREBY ACKNOWLEDGE THAT I' HA READ THIS APPLICATION AND STATE THAT THE ABOVE IS COR CT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COU TY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OW ER THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PIT IS ❑ CESSPOOL$ 0 \ OF PERMIT TE VALIDATION ROBERT A. WOOD cK Y.0. CASH SUPERVISING MECHANICAL ENGINEER :v ca I' L 6 5 08.o PJ1v U 5 1 0 D 7.0 0— �.