HomeMy Public PortalAbout6158 BURTON AVE_Sewer__ E80
C68.ee APPLICATION FOR PERMIT
eaoe COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A LAMBIE, County Engineer ADDRESS �. cS T •b -rTU l
CASSATl' D. GRIFFIN, Supt of Building �J r
LOCALITY. \ 17 At
NEAREST
FOR APPLICANT TO FILL IN caoss sr. —c
LEGAL c
DESCRIPTION LOT NO. 0 OWNER -C 1 CX/
BLOCK TRACT qQ,� MAIL
ADDRESS 0— ✓ C
NO.OF BLDGS.
SIZE OF LOT O ° / , NOW ON LOT CITY 9 N'
USE OF 46
BUILDINGS (�� DISTRfNO.I GROUP MAP P CESSEO Y
BK PG
CONTRACTOR C'r'V "j- `_ ,
ADDRESS'/0 Xy �•�7-p A' Com. CONNECTION DATA
CITY I NV TEL.NO. '3 �La,_T STATION DEPTH
y STATE MANHOLE REFERENCE
/,
REGISTRATION NO. �� "] q BJ )S–/ COUNTY OWER
NO. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P_.L. j M.L.TO P.L. Q
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN_CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO CO.IMP, N0. P.C.B No.
PRIVATE DISPOSAL SYSTEM @ SI.00 / JO
CONNECT ADDITIONAL BLDG. TRUNK PERMIT NO. ROAD PERMIT N
WORK TO HOUSE SEW @ $1.00bIN HOUSE STATE PERMIT N
5 LSYSTEM @ 51.00 PERMIT NO.
INDUSTRIAL
WAS TEAP OVAL
CHARGES
OWNERS PERMIT $ 22 –0e0 CONNECTION CHARGE FEE
3
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
THE HEREIN NAMED CON-
TRACTOR TO CIONNECT THE ABOVE EDATE A CONTRACTIS RIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THISDA OF – 19/S NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT– BUILDING OR WORK
ADDRESS / SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL El
WI
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SEWER EM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR AND
PLUG D
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT CT PLUGHOUSE D
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT[A PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEE'.'ITIS) ❑ CESSPOOLS ❑
bF PERMITTE
®" ALIDATION ROBERT A. WOOD
CK.f M.0. cAgR SUPERVISING MECHANICAL ENGINEER
("5. 583 - JAN 251 0 A 3.00
DEPAKTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUD
WILLIAM
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 1 �/3di2.TDiC/
FOR APPLICANT TO FILL IN LOCALITr L/ =:;n
BUILDING 615'8 Burton Ave. _ CROSS ST._� j,w'/
ADDRESS
LOCALITYDISTRIC=t{0. SERIAL NO. PERMIT NO.
5214 Garriol � �a� � c�ia A /S.
C `SS ,3
ROST. Longden �7
RECEJVF�.BV� Ready for Inspection
OWNERMAIL
ADDRESS 110 Santa Ana Ave. IrI S/E�/ZjO N_E�/^ �.O/C/JCU PANCY /� OK MICP PG
CITY Long Beach TELAO. 957'25 V/
�"G„ r /�.,/�5� 12?
CONTRACTOR R . Tnmi Ch CO.IMP.NO.
ADDRESS 5922 N. F,ncinita Ave, JOB NO.
CITY Temple City TEL.NO.At 63X6 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 85271 COUNTY ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT✓ -5— 9 46 ,13 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT /OD N�O NO.OF BLOT 7
[� NOW ON LOT Gam' CHARGES
USE OF
BUILDINGS �� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO J�
PUBLIC SEWER @ S 3.50 �(/ RECEIPT NO. DAT\ I BY
HOUSE SEWER CONNECTING TO
P R IVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTION RECOR ED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING J NO' I DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ��.
PITS AND/ORDRAELLELD 2.00 STATION / 75' DEPTH
CESSPOOL—CONDITIONS
69
SPECIAL CONDITIONS ONLY 2.OD /I C WANUHOLE PPERREFERENCE LOWER
TYPE OF CON ECTIO LENGTH FROM
00 `�
OWNERS PERMIT S ( 0 '� CP'}✓ M.L.TO P.L
AUTHORIZATION TOTAL FEE _10
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS.... DAY OF _ .... ...... .......19: �.�NEw HOUSE SEWER �-/71
OWNER OR CONNECT ADDITIONAL
OWNERS AG .............. -----
SEPTIC
BUILDING OR WORK
ADDRE . . .QiJ1, e�'!: .... . /.�. SEP/OR DRAINFIELD PIT(S)
P.NO
I HEREBY ACKNOWLEDGE THAT I HAVE RE THIS APPLI. CESSPOOL E] DRYWELLCj
CATION AND STATE THAT THE ABOVIS CORK C
E T AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES A D STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND /
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESID TIAL PROPER Y. BACKFILL SEPTIC TANKS ^ �_
SIGNATURE SEEP.PIT(S)� CESSPOOLS ��
OF PE RMITTEE.._. ._�_
76AG42A 663 7/53