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HomeMy Public PortalAbout6006 BURTON AVE_Sewer__ 76A6420 -CE808 -10.71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS O©� /_' N. Burton Ave. LOCALITY . San Gabriel NEAREST FOR APPLICANT TO FILL IN CROSS ST GaribaldiAve. LEGAL ] Milton Bade DESCRIPTION LOT NO OWNER PM 3526 MAIL BLOCK TRACT "OGRESS 20 Birchcroft NO. OF BLOTS. Arcadia TEL. NO. 512E OF LOT NOW ON LOT CITY USE OF BUILDINGS Res.S DISTRICT N0. GROUP MAP OCESSED BY SI( Pi CONTRACTOR S uare Deal Sewer Service -2:: G ` ADDRESS 2933 Maxson Rd. !I� CONNECTION DATA CITY El Monte TEL. NO. 444-2020 STATION /��� DEPTH STATE LICENSE NO, 1.28870 GLFBB MANHOLE REFERENCE 1,3 / LOWER NO. I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM "fQ HOUSE SEWER CONNECTING TO ,.` Y. VRB P.L. M.L.TO P.L. Cj.,( PUBLIC SEWER @ $7.00 oo SEPTIC IA N K.SEEPAGE PIT OR 2 O JOB P'C.NO' PITS AND/OR GRAINFIELD ® $10,00 CO.IMP. NO. 3 NO. HOUSE SEWER C ONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. J� 1 PRIVATE DISPOSAL SYSTEM @ 53.00 J CONNECT ADDITIONAL BLDG.OR O AFFIDAVIT uv su[ry RECORD.INSTR.NO. DATE 0 WORK TO HOUSE SEWER 33.GO OVERFLOW SEEPAGE PIT.GRAINFIELD K E%TN..C ESSPOOL,DRYWELL. ® S5OO O ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING I- SEWER OR DISPOSAL SYSTEM Q $3.00 STATE ENC ROwCHMENT W MANHOLE ® $7.00 PERMIT NO. D_ INDUSTRIAL N WASTE APPROVAL Z OWNERS PERMIT s a 00CHARGES AUTHORIZATION TOTAL FEE //6Vh CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EEISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE CTO RS SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDI ADDRESS SEPTIC WORN TANK, SEPTICGRAI SEEP.FIT(S) I HEREBYTHAT THEAB ACKNOWLEDGE E IS RRC READ THIS APPLICATION AND/OR GRAINFIELD AND STATE COUNT TXE ABOVE IS CORRECT TE AGREE E COMPLY WITH ALL COV NTT OROINA NOES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSED A5 REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM THETXE LEG OF. AND INTEND TO DISCONNECT PLUG AND RES IUORN IN. THE ABOVE DESCRIBED RESIDER AL P OPERTY. ABANDON CT L G WED -NAT= `/Q / BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ( C ❑ SEEP.PIT(51 ❑ CES POOLS VALIDATION OK. M.O. CASH v'7 6 tf 7wuo[ ..Y 1 U A