HomeMy Public PortalAbout10647 BOGUE ST_Sewer__ • D
S E-663 3.55 A PLICA ION- ■ ®R PERMIT
7
S&E-6 __ ■
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L X81
Department of County Engineer BUILDIN�7�
County of Loa Angeles ADDRESS . StWM.J. FOX, COUNTY ENGINEER -- -
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITFOR APPLICANT TO FILL IN ceOSS sr. Ave,
LEGAL
DESCRIPTION LOT NO. 8 J OWNER Miller and Price
MAIL
BLOCK TRACT 17158 A DRESSx()40rl T-
L-1a ,inar•Dr
N0. OF BLSan. Gabriel TEL. No. fs.t. — 00
�Q x- 23 NOW ON LOT
CITY
SIZE OF LOT 1
USE OF
BUILDINGS 1rellln DISTR IP MAP
BK PG
CONTRACTOR
ADDRESS 1 CONNECTION DATA
-:TY�4
TEL. N0.
y STATION 4 . S�, DEPTH /
TATE MANHOLE REFERENCE
REGISTRATION NO. j�.j, � ❑ COUNTY
No. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO TYPE ONNECT10�1 LENGTH FROA7 / /
P.L LEN.
TO P.L. b
�= PUBLIC SEWER Q $ '3.50 �
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR P. C. NO. 5_7/WORK TO HOUSE SEWER 1.00 CO. IMP. NO. .if�tJ1?.
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 CON DITIO NS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVECON-
TRACTORTTOS CONNECT THEDATEAABOVE DESCRIBED EXIISTINGWITH THE HEREIN, AMED DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER -
SIGNED THIS -DAY OF 19- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT 1� 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 '
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 AM THE LEGAL OWNER OF THE ABOVE -ABANDON HOUSE SEWER
DESCRIBED RES IDENTI - OPERTY BACKFILL SEPTIC-TANKS C
/� SEEP. PIT(S) ❑ CESSPOOLS[]
SIGNATURE ' �G
OF PERMITTEE '
WILLIAM J. FOX, COUNTY Er INFER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
'_' .2585 M0120 4 4-.5 Don