HomeMy Public PortalAbout10637 BOGUE ST_Sewer__ D
S&E-669 9-85 APPLICATION- FOR PERMIT _
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL."
Deportment of County Engiaeer
County of Loa Angeles BUILDING
• WM.J. FOX, COUNTY ENGINEER ADDRESS •10637 BO=1P st
® ',&SSA.TT D. GRIFFIN, SUPT OF BUILDING LOCALITY Tample City
NEAREST -
FOR APPLICANT TO FILL IN CROSS ST.LEGL '
DESCRIPTION LOT NO. 6 • OWNER hiller and,Price
BLOCK TRACT AIL
1 158 ADDRESS
r '� 8640 F Las Tl)has Dr.
NO SIZE OF LOT 50 X 130 NOWOON LOTS 1 CITY San Gabriel TEL. NO.At. 7-3007
USE OF
BUILDINGS Dwel I ing DISTRICT NO. I GP I MAP
BY, Y PG
CONTRACTOR
ADORES _' CONNECTION DATA
CITYI TEL. N STATION pDEPTH ,
_ ❑ STATE MANHOLE REFERENCE - 9- UPPER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CO NECTIO LENGTH FROM Q Q
F HOUSE SEWER CONNECTING TO Yay P.L. M.L. TO P.L. '
_ PUBLIC SEWER @ $ 3.50 s
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00- �/'
CONNECT ADDITIONAL BLDG. OR CO. IMP. N0. P.iA6-�FYi.. TO
WORK. TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
r
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 t oo
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORTTOS CONNECTDATE ONTRTHEA ABODVEWDESCR BEDITH THE H EXISTINGEREIN A DWELLING CON APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT 1 A X) BUILDING OR WORK
�
SEPTIC TANK,SEEP, PIT(S)
ADDRESS , AND/OR DRAINFIELD
I HEREBY 'ACKNOWLEDGE THAT 1 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
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 RES I DENT IAL,.E95PERTY. _ BACKFILL SEPTIC-TANKS
SIGNATURE [;.
SEEP. PIT(S) [I CESSPOOL❑
�, f
OF PERMITTEE ,
WILLIAM J.FOX. COUNTY ENG EER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
'.,co 2 5 8 5 NOV 20 4 4.50 � .
• ., `tel � � ��\.