HomeMy Public PortalAbout10636 BOGUE ST_Sewer__ D
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63 3.35 PPLICATION. FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D I S POSA L
Department of County Engineer
County Of LOS Angeles
rB
ILDING
WM.J. FOX, COUNTY ENGINEER DRESS 10636 BogLte St.CASSATT D. GRIFFIN, SUP'TOFBUILDING CALITY Temple City
FOR APPLICANT TO FILL IN
NEAREST. Live Oak Ave.
LEGAL
DESCRIPTION LOT NO. 3 O OWNER i-i l l _ and Price
BLOCK TRACT 17158 ADDMAI RESS 8640 E. Las T1a.na.S Dr•
SIZE OF LOT 0 x 136 NOW ON LOTBLDGS 1 CITY 7-3007
S San Gabriel TEL, N0. !it•
USE OF
BUILDINGS ]Dwelling DISTRICT N I GROUP I MAP —
1 BK PG
CONTRACTOR ,,��A
ADDRESS
' ' u CONNECTION DATA
i
CITY TEL. N0. STATION 2 r� Q DEPTH
�� ❑ STATE MANHOLE REFERENCE Iy�' � UPPCR
REGISTRATION NO. �
1 t� ❑ COUNTY �7 �� v• -
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO •-� TYPE OF CONNECTI LENGTH FROM
PUBLIC SEWER Q $ 3.50I �S L/ - Y. CURB P.L. M.L. TO P.L. a"TJ
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.t14 9
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. i^n N0•
ALTER ORREPAIR EXISTING
SEWER R 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 _
OWNER'S PERMIT S 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVE CON-
TRACTORTHIS DATE TO CONNECT THEAABOVECTED WDESCR DESITH THE CRIBED HEREIN NAMED
EXSfING
DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS -DAY OF 19
q, CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT _
SEPTIC TANK,SEEP, PIT(S)
ADDRESS , AND/00DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL C3AND 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
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED 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—PILOPERTY. BACKFILL SEPTIC TANKS C
SEEP.-PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE '
WILLIAM J.FOX.COUNTY ENG I R VALIDATION R.A.WOOD, CHIEF FLBG. INSPECTOR
;��,-5 8 3;r ;av2o 4 4-50