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Home My Public Portal About5017 CLOVERLY AVE_Sewer__ • TEMPLE CITY CA642D D_82 7APPLICATION FOR PERMIT 70A 642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIOL�j. BUILDING 5017 N. Cloverly V. JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of BuilE4aTemple City NEAREST FOR APPLICANT TO FILL IN RD LOCALITY ST T.2 Rnsa LEGAL DESCRIPTION LOT NO / OWNER ebb BLOCK TRACT -2 e_1 MAIL ADDRESS1700 S. Garfield NO F SIZE OF LOT NOWOON LOTS CITY Alhambra TEL NO USE OF Res . BUILDINGS Res • DISTRICT NO GROUP MAPPROCESSED BY BK CONTRACTORSquare Deal Sewer Service !�� /-/ I ADDRESS2933 Maxson Rd. ^/ ^/2 /// CONNECTION DATA /J CITYE1 Monte TEL NO GI 1+-2 ATION `< DEPTH Jr ❑ STATEMANHOLE REFERENCE J >_REGISTRATION NO El COUNTY _< LOWER G. NO DESCRIPTION OF WOIRK FEE TYPE FCO N ON LENGTH FROM O 1 HOUSE SEWER CONNECTING TO 5 00 Y P L M L TO P L V PUBLIC SEWER @ $5 00 PC NO IIX SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $1000 CO IMP NO ) JOB NO {`0` HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO �� W PRIVATE DISPOSAL SYSTEM @ $300 5 YYYYJJJJ CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT RECORD INSTR NO DATE h WORK TO HOUSE SEWER @ $300 Z OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL,DRYWELL MANHOLE @ $500 HWY OR ST WID NTNG ALTER REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENC A MENT PERMIT N (1 INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2ro' CHARGES AUTHORIZATION TOTAL FEE 00 CONNECTION CHARGE FEE I HAVE 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 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDVOR ALTER,REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AN INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PR ERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CdKM O CASH SUPERVISING MECHANICAL ENGINEER CK L4CO 5 3 6 8* OCT 2 9 1 0 D 7.0 0 r ` TEMPLE CITY ` t0_B2 78A APPLICATION FOR PERMIT AO4 842D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �T JOHN A. LAMBIE. County Engineer ADDRESS 50l N. Cloverly AV. WILLIAM A. JENSEN• Supt of Building LOCALITY Temple City NEAREST N FOR APPLICATO FILL IN `.055 5T La Rosa LEGAL DESCRIPTION LOT NO OWNER Lew Webb MAIL 1 00 S. 'Garfield BLOCK TRACT / ADDRESS SIZE OF LOT NOWOON LOTS CITY Alhambra TEL NO USE O F DISTRICT NO GROUP MAP PG PROCESSED BY BUILDINGS Res CONTRACTORSquare Deal Sewer ServiceK 3 ADDRESS 2933 Maxpon Rd. CONNECTION DATA 020 S TION DEPTH y CITY TEL NO J STATE MANHOLE REFERENCE } REGISTRATION NO LI COUNTY LOWER CL NO DESCRIPTION OF WOR FEE TYPE OF CONN C LENGTH FROM O HOUSE SEWER CONNECTING TO Y j C P L M L TO P L 3.S V PUBLIC SEWER $5 00 SEPTIC TANK SEEPAGE PIT OR P C NO PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERM] O PRIVATE DISPOSAL SYSTEM @ $300 �LLLLJJJ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE h WORK TO HOUSE SEWER @ S300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY R T E N L SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ACH MENT O Saddle 2 00 PERMIT INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ CHARGES AUTHORIZATION TOTAL FEE 25 00 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FE E TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF _19— OWNER 9_OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ 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 ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER F AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENT L P PERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ V LIDATION ROBERT A. WOOD cK M O CASH SUPERVISING MECHANICAL ENGINEER L�Ca5369-0 OCT 29 11 D 25.00^ . 1