HomeMy Public PortalAbout6004 BURTON AVE_Sewer__ 16 A'$d2D—CER08 - 10_11 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER q
BUILDING AND SAFETY DIVISION BUILDING VO N. Burton Ave.
ADDRESS
LOCALITY San Gabriel
FOR APPLICANT TO FILL IN
114 REST
Garibaldi Ave.
`EGA` Milton Bade
DESCRIPTION LOT NO. 2 OWNER
PM 3526 MAIL
BLOCK TRACT ADDRESS 20 Birchcroft
NO. OF BL 05.
SIZE OF LOT NOW ON LOT CITY Arcadia TEL. NO..
USE OF Res.
• DISTRICT NO. GgODP Pi
MAP CESSED BY
BUILDINGS II
BK
CONTRACTOR Scuare Deal Sewer Service —
ADDRESS 2933 MaXSOn Rd1'.111 CONNECTION DATA
444
CITU
El Monte TEL. NO. -2020 STATION /��l�r�i / DEPTH
STA L.0
I•
LICE NSC NO, 1,28870 CL SS c_42 MANHOLE REFERENCE / ('V / LLOOW R
NO. I DESCRIPTION OF WORK FEE TYPE OF CONNE< 1 N LENGTH FROM
.1 HOUSE SEWER CONNECTING TO 00 Y. M.L.TO P.L.
J PUBLIC SEWER 0 $1.00
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD SO'.
CO.IMP.NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT IVNO. ROAD PERMIT NO. / S D-
PRATE DISPOSAL SYSTEM f3.GO / O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT AYI. RI51R41.1RECORD, INSTR.NO. DATE U
WORK TO HOUSE SEWER ® 33.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL. ® ES.00 Q
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING H
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT VW
MANHOLE @ $7.00 PERMIT NO. 1
N
INDUSTRIAL
WASTE APPROV AL
CHARGES
OWNERS PERMIT s 3 00
AUTHORIZATION TOTAL FEE 3.0 ()0CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRCTOTOA THERTO P UBLCC SEWER ONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER Ilf z=�
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING ORRK
WORWORN
SEPTIC TANK,SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANG/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/ON ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RES IDENTI PROPERTY, ABANDON HOUSE SEWER
SIGNATURE r
OF PER MiTTEE BACKFILL SEPTIC TANKS ❑
S EEP,PIT IS) CESSPOOLS
VALIDATION CK.. "" O CASH
a0 6- 4pOCT 291 0 A 1 0.0 0 Aqb
16A 642D-CEB08 -10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS BUaDING 611014(' N.
'p N. Burton Ave.
b
LOCALITY San Gabriel
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. Garibaldi Ave.
LEGAL2 Milton Bade
DESCRIPTION LOT NO. OWNER
PM 352 MAIL
BLOCK TRACT ADDRESS GO Birchcro t
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY Arcadia TEL. NO.
F O
USE Res. DISTRICT NO. BgOUP MAP SSBUIED BY
USE NG$
BN /P$ �
CONTRACTOR S uare Deal Sewer Service 5 — 6
ADDRESS 2933—Maxson Rd_• CONNECTION DATA
CITY El Mont/eJ TEL. NO. LI.LI.LI.-(l //jj STATION DEPTH
STALICENSE NO. I.28H O `IC C.4(_ MANHOLE REFERENCE / '�"gR
CIC
LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONN CTI LENGTH FROM l�
HOUSE SEWER CONNECTING TO Y. CU M.L.TO P.L.
PUBLIC SEWER S7.00
P.C.NO.
SEPTIC ANKSEEPAGE PIT OR CO.IMP. NO. JOB NO.
PITS AN./OR OR oRAINFIELD ® {10.00 }
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 0.
PRIVATE DISPOSAL SYSTEM ® $3.00 O
CONNECT ADDITIONAL BLDG.OR gFFIOAV IT MV[II 5[Y[x qEC ORD.INSTR. NO. DATE u
WORK TO HOUSE SEWER @ $3.0.
OVERFLOW SEEPAGE PIT.GRAINFIELD
EXTN..CESSPOOL.ORYWELL. a 55.00 O
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING F
SEWER OR DISPOSAL SYSTEM 53.00 U
STATE ENCROACHMENT W
MANHOLE $7.00 PERMIT NO. d
INDUSTRIAL y
]. Saddle 30
yy WASTE APPROVAL Z
OWNER'S PERMIT S q0 cHARG Es
AUTHORIZATION TOTAL FEE 3
O OO CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORN
- BE PTIC TANK.SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE REAG THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES -_5O
OU TY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNE OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE OESCFI BEp gEBIpEN qL P OPERTY, ABANDON MOUSE SEWER
SIGNATURE /JF
OF PERMRTEE �Y� BACKFILL SEPTIC TAN" ❑
SEEP,PIT IS) BBPOOLS ❑
VALIDATION <K.. M.B. CASH
0-73
1 -"P1OCT. 291 1 .A. . .. . 3 0.0 0 A9E