HomeMy Public PortalAbout10632 BOGUE ST_Sewer__ 76A642D APPLICATION FOR PERMIT
MIT
S B E-663 3.55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer BUILDING
County of LOS Angeles _ADDRESS �C1Fi ? R(�,c�7p�t�
\1 WM.J. FOX. COUNTY ENGINEER '9
II® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY Te-9-ple City
FOR APPLICANT TO FILL IN 'CIE S,s. Live Oak Ave-
LEGAL
v ,LEGAL and Price
DESCRIPTION LOT N0. L1. OWNER Miller -
BLOCK TRACT - - MAIL
'ADDRESS 8640 E. Lab (I1 unaSDr.
SIZE OF LOT '50 X 144 NO. OF 8L
NOW ON LOTT * land Garai CITY San ,Gabriel TEL. No. At. 7- 007
USE OF
BUILDINGS DISTRICT GROUP MAP -
BK PG
CONTRACTOR ,
ADDRESS CONNECTION DATA /
CRY TEL. NO.�j/ ,STATION S DEPTH 4
/ J � f ❑ Sl' E MANHOLE REFERENCE ///r / /,/J01w _ UPP R
REGISTRATION NO. 5 /V_ ❑ COUNTY
NO. DESCRIPTION OF WORK - FEE
HOUSE SEWER CONIJECTING TO / Y TYPE OF CONNECTI P L 'ELGTOH P OM
PUBLIC SEWER $ 3.50 J
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOBS
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER - STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL VdASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT g 1 00
AUTHORIZATION TOTAL FEE `� Y, -REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED 'WITH THE HEREIN NAh ED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC-SEWER
NEW HOUSE SEWER
SIGNED THIS -_DAY OF 19_ 4� �;<� � L'iJa
CONNECT ADDITIONAL
OWNER OR
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS-APPLICATION CESSPOOL El' DRYWELL[3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -ALTER, REPAIR, SEWER-OR
-
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I'AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY -LOS ANGELES-COUNTY AND STATE-OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. .BACKFILL,SEPTIC•TANKS❑
SEEP- PIT(S) ❑ CESSPOOLS❑
SIGNATURE -
OF PERMITTEE
WILLIAM J.FOX.COUNTY ENGIN! ER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
- ,2584- m. Z 4 4_.5.0 �'