HomeMy Public PortalAbout10633 BOGUE ST_Sewer__ S E-6633 3.50 APPLICATION FOR PERMIT
5&E-6
DIVISION OF BUILDING AND SAFETY SEINER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDINGADDRESS 10533 ' Bot>e Stm
WM.J. FOX. COUNTY ENGINEER
® CXSSATT D. GRIFFIN, SUPT of BUILDING LOCALITY Temple City
MOMFOR APPLICANT TO FILL IN ceoss sr. L' Oat: Ave,
DESCRIPTION LOT NO. rj OWNER- Miller and Price
MAIL
BLOCK TRACT 17158 ADDRESS 8640 E. Las Tunas Dr.
NO. OF BLDGS.
SIZE OF LOT 50 7C- 144 NOW ON LOT 1 and GFe CITY San Gabriel TEL. No. At. 7-3007
USE OF
Dtdellino� -
BUILDINGS DISTRICT ( GP I BK PG.
h-1A'P�^
CONTRACTOR
ADDRESS ame CONNECTION DATA
STATION /� DEPTH /
CITY TEL. NO. Q
� � / (..C+)�/ C!
❑ STATE MANHOLE REFERENC' PPER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTIO 'ENGTH FROM
P.L. h1.L TOP L. '3/
PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. ORNO. O 7��
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. 799�f7'tr�
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 WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00 -
AUTHORIZATION TOTAL FEE 0 REIMBURSEMENT FEE
IHAVE CON-
TRACTORTTOS CONNECT DATE O THE ABOVE WDESCR BED EXIST[NGITH THE HEREIN ADWELLI NG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS _DAY OF 19- NEW HOUSE SEWER
OWNER OR /� CONNECT ADDITIONAL
OWNERS AGENT /[ BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD '
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'CESSPOOL❑ DRYWELL❑
AND 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 '
1 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 RESIDENTI PERTY. BACKFILL SEPTIC.TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE —'
OF PERMITTEE
WILLIAM J.FOX.COUNTY ENGI R VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
s
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