HomeMy Public PortalAbout10646 BOGUE ST_Sewer__ D
S&E-6G3 3.55 APPLICATION FOR PERMIT
5& -B
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angeles BUILDING
ADDRESS 106%6 Bogue St.
WM.J. FOX, COUNTY ENGINER
® CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY Tem-ple Cit
FOR APPLICANT TO FILL IN NEAREST
LEGAL
DESCRIPTION LOT NO. ]_ OWNER Miller and Price
BLOCK TRACT Q MAIL pC''^ n,
1715. ADDRESS 8640 E. Las l snas Dr.
NO. OF BLDGS.
_ SIZE 00'LOT 570 x 164 NOW ON LOT 1 CITY TEL. NO. At.' 7-3007
USE OF 'Man aabgigl
BUILDINGS ' DISTRICT NO. I GROUP I MAP `-
BK PG
CONTRACTOR
V
ADDRESS CONNECTION DATA
CITY TEL. STATION / 1-_70 - 0 DEPTH ,
❑�� STATE MANHOLE REFERENCE �'� ,/ UPPER
REGISTRATION N0. ❑ COUNTY � � LOWER !
NO. DESCRIPTION OF WORK FEES;
HOUSE SEWER CONNECTING TO TYPE OF CONNECTI LEIIPTH FROM
PUBLIC SEWER Q $ 3.50 �� Y' CURB P.L. M.L.
TO P.L.
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.
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 g 1 o0
AUTHORIZATION I TOTAL FEE Lf- t6`0 REIMBURSEMENT FEE
I HAVE DATECON-
TRACTORTTOS CONNECT THEA CTED ABOVEWITH DESCR BEDTHEH EREIN EXISTINGAMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER fv, e
SIGNED THIS _DAY OF 19- NEW HOUSE SEWER
ti".� rl ✓ G
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S) '
ADDRESS AND/OR DRAINFIELD
I 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
V 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 0�-- 'NDON"HOUSE SEWER
DESCRIBED RESIDENTIAL RJZQPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PITS) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX, COUNTY ENGIN EE VALIDATION R.A.WOOD,CHIEF PLBG. INSPECTOR
i A,L.'02 5 8 OV20 4 4.50