HomeMy Public PortalAbout6164 BURTON AVE_Sewer__ "A°Aa°
C11008 e-as APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION _ BUILDING ,L�
g ADDRESS 'w / G
CASSATTOHN AD.GRIFFIN Sup County of 9B�uilding �'
LOCA LITT /.J R J. r
NEAREST
FOR APPLICANT TO FELL IN CROSS sr. G Cst/.
LEGAL
DESCRIPTION LOT NO. OWNER I' r
BLOCK TRACT � �0� MAIL '
ADDRESS (]sem— /J !Y-6''P ✓ C•
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT CITY N c1 A«�0. TEL. N0.
USE OF
BUILDING$ DISTRICT NO. GROUP MAP PR ESSED B
CONTRACTOR ! CEA �BK 1G _/ j
ADDRESS 0..�-2' /C y.G�.-�p.E, CONNECTION DATA -
CITY A/v /'TEL.NOf �-� a",:Z�,� STATION DEPTH
REGISTRATION NO. // 4/—/ t�� C� 1 COUNTY STATE MANHOLE REFERENCE �- LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROMSEPTIC TANK.SE �j O
PITS AND/OR DRAEINFIELDT OR @ $3.00 Y. CURBK.L. j M.L.TO P.
OVERFLOW SEEPAGE PIT.DRAINFIELD
E%TN..CESSPOOL.DRYWEI I @ $2.00
HOUSE SEWER CONNECTING TOP.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO.� JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
AL4ER-RffMR'BR�ABA.00 N HOUSE STATE ENCR T
SEWEROR-Oi�G¢BBRLSYSTEM @ $1.00 PERMIT NO.
INOU STR IAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 2 00 CONNECT)ON CHARGE FEE
AUTHORIZATION TOTAL FEE 3 UZO REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING NG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP. PITS)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING A LTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEW AGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGI STEREO ANO/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOB ANGELES COUNTY AND STATE OF pSANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PR ERTY. /% \ SACKFUL SEPTIC TANKS ❑
SIGNATURE (�RpY.y SEEP. ILL SE ❑ CESSPOOLS 0
OF PERMITTEE 1,
ALIDATION ROBERT A. WOOD
t%.
9.0. GSH SUPERVISING MECHANICAL ENGINEER
LAC05 5 s a$ IAN 25 1 0 A 3.00
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUaO:Nc
WILLIAM J. FOX, COUNTY ENGINEER ` ADORES$
FOR`AP/ LICANT TO FILL IN LOCALITY
BUILDING 616 - Burton .Ave. NEAREST
ADDRESS CROSS ST.
LOCALITY San Gabriel, Calif• DISTRICT N6. SERIAL NO. PERMIT NO.
NEAREST A OR S
CROSS ST. Longden Avenue RE IVEDB �� Rcady for Inspection DAVE ISS ED
OWNER E. N. Guiffra ��� ��,Z115*
MAILADDRESS 110 Santa .Ana Ave. FUSE ZONE OCCUPANCY fBKAOI P
CITYLong Beach TEL–NO. 95725 / /0� s 12il
CONTRACTOR A. S. TOIlllE E.`� CO.IMP.NO.
ADDRESS 5722 N. Encini.ta5 1Ave. JOB NO. !
CITY Temple City TEL.NOAt 65&6 TRUNK PERMIT NO
85271 STATE
REGISTRATION NO. COUNTY ROAD PERMIT N0.
LEGAL ✓ 9' STATE ENCROACHMENT
-DESCRIPTION
LOT NO. PERMIT N0.
BLOCK TRACT✓.:J 9 %� INDUSTRIAL
/ WASTE APPROVAL .
SIZE OF LOT e,01,0NO-O BDG NOW ON LOTS CHARGE
USE OF
BUILDINGS r CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT ENT FEE
PUBLIC SEWER @ $ 3.50 . RECEIPT N0. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RE HOED
A
WORK TO HOUSE SEWER 1.00 N0. I pAIBY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPY—ICTANKSEEPAE
PITS ND/OR DRAINFGELDIT OR 200 STATION �(7
CESSPOOL—DRYWELL �-
SP ECTAL CONDITIONS ONLY 2.00 A }M1I ANHOLE REFERENCE
V .I480£R LOW E
TYPE OF CON N ECTIZrLENGTH FROM
OWNERS PERMIT S 1 00 `p M.L.111"TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HERE N NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INS PECTO R'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEWER/,p/
SIGNED THIS._a:---_.DAY OF..!4.. .__._.._.19_�� NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENTX--- . .L.._.._.. .__..__ BUILDING OR WORK
EPTIC
ADDRESS...`.1.Q..��'.._ M...W...' :T:!:`''..L......_..... ..... ...._.. S ND/OR DRAINFIELD ITIS)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLI- CESSPOOL Ej DRYWELLC
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND /
ANO/OR LICENSED AS REQUIRED By LOS ANGELES COUNTY ABANDON HOUSE SEW ER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDEj/7JAL PROPERTY. BACKFILL SEPT ICTANKS Q
SIGNATURE f SEEP.PIT(S)E] CESSPOOLS./
OF PE RMITTEL ( -� U
._.._....i. ...... .. _..
76AG42A 663 7/53