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HomeMy Public PortalAbout10641 BOGUE ST_Sewer__ 6 E-6D S 63 3.55 APPLICATION FOR PERMIT E-6 _ DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL _ Deportment of County Engineer BUILDING County of Loa Angeles ADDRESS 10641 Bowe Street WM.J. FOX, COUNTY ENGINEER ® CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY 1 emmln City FOR APPLICANT TO FILL IN CROSS ST. LEGAL r� DESCRIPTION LOT NO. / p OWNER FniI l/Pr =nfl Ari CA - 'BLOCK TRACT 17170 ADDRESS 864'0 E.-La's Tunas Dr.. SIZE OF LOT rjn Z- ��� NONO W ONOF BLOTS CITY TEL. NO. Say .Gabriel At.. 7-30071 USE OF BUILDINGS Pjqelling DISTRICT NO., GROUP B MA P CONTRACTOR - I• ADDRESS CONNECTION DATA �p / CITY- TEL. NO. STATION Z' Z o s V DEPTH v 00 rT ATE MANHOLE REFERENCE REGISTRATION NO. e13 '�'��p ❑ COUNTY • ` 0 No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO -� TYPE OFsp NNECTIO LENGTH FROM 4�^ PUBLIC SEWER Q $ 3.50 @ 'B� M•L. TO P.L. t./ HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM -1.00 CONNECT ADDITIONAL BLDG. OR P. C. N0. WORK TO HOUSE SEWER 1.00 CO. IMP. NO. 'i6B'1M9. © ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AMD/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 g 1 00 AUTHORIZATION I TOTAL EEE REIMBURSEMENT'FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER SIGNED THIS OF 19— NEW HOUSE SEWER OWNER OR s CONNECT ADDITIONAL F�•s� ��""`'�!�/�' OWNERS AGENT— �'- &&&N&&./// 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 IHEREBY 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 ITHE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTI RO ERTY. BACKFILL SEPTIC TANKS❑ _ SEEP. PIT(S) ❑ CESSPOOLS❑ SIGNATURE OF PERMITTEE WILLIAM J.FOX.COUNTY ENGI R VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR ��;r 2 5 87 �U 20 4 4:5.0 �