HomeMy Public PortalAbout5104 DOREEN AVE_Sewer__ APPLICATION FOR PERMIT r
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 111LIUsa 5104 Doreen Street
JOHN A. LAMBIE. COUNTY ENGINEER _
COLEMAN W. JENKINS'. SUPT. OF BUILDING - '-
LOCALITY Tem 1 it
NEAREST
FOR APPLICANT TO FILL IN °"OSE 5T.
EGAL
DESCRIPTION LOT NO. OWNER John Marsall Construction
MAIL
BLOCK TRACT ADDRESS 1010 F.
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITY San Gabrie-IL. NO. 286-9822
USE OF
BUILD I NOS DISTRICT NO. GROUP MAP PROCESSED BY
O BK PG
CONTRACTOR Owenl �D
ADDRESS 4265 No. Baldwin ve. CONNECTION DATA
CITY El Monte 917311EL. ND. 443-0078 STATION DEPTH
STATE
TCENSE NO. 231741 LIC C-36 MANHOLE REFERENCE
LOWER
NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTROM
HOSEWER f5.00 OOUSE SEWER CONNECTING TO Y CURB P.L. M.L.TO .L.
1
SEPTIC TANK,SEEPAGE PIT
P
ITS AND/OR GRAINFIELD j10.00 CO.I.P. NO. JOB NO.
HOUSE SEWER CONNECTING TO -PRIVATE DISPOSAL SYSTEM TRUNK PERMIT NO, RDA.PERMIT NO.
® g3.00 O
CONNECT ADDITIONAL BLDG,OR pFFIpAVIT MY 5[M[XL RECOfl°.INSTR.NO. DATE U
WORK TO HO USE.SEWER 0 33.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
O
E%TN..CESSPOOL,ORYWELL.MANHO LES E5.00
ALTER,REPAIR OR ABANDON HOUSEr HWY. OR ST.WIDENING • U
SEWER OR DISPOSAL SYSTEM a $3.00 W
STATE ENCROACHMENT G-
PERMIT NO. h
Z
INDUSTRIAL
WASTE APPROVAL
1
OWNER'S PERMIT $ j DG CHARGES
AUTHORIZATION TOTAL FEE GG CONNECTION CHARGE FEE
1PE1MBUR5EMENT FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO.CONNECT THE ABOVE DESCRIBED EX15TING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'5 SIGNATURE
SIGNED THIS DAV OF 19_
OWNER OR NEW HOUSE SEWER,
OWNERS AGENT_ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT IB)
ANO
STATE THAT THE PROVE IS CORRECT AND AGREE TO COMPLY gN°IOR ORAINFtELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR gLTER.REP AIR.SEWER OR _
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE °F SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO
RESIDE IN, THE ' DISCONNECT PLUG ANDD . ABANDONUSE
WED
SIGNATURE I - BACKFILL SEPTIC TANKS ❑
OF PEgMTTTEE V� SEEP.PIT(S) ❑ CESSPOOLS ❑
VALIDATION JACK R. ALLEN
CK., M.D. CASH SUPERVISING MECHANICAL ENGINEER
9 7 7 7�1 8FR1 9 1 0 D 55.00— €=
e �
CEBOB3-63 APPLICATION FOR PERMIT
76AB42D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /�
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 104 N. Dcreen
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple C1$V
•
NEAREST
FOR APPLICANT TO FILL IN EFBES BE
T l ' fTy
EGALMr. Mike Marshall
DESCRIPTION LOT NO. 8 OWNER
MAIL
BLOCK I'D" TRwCT 11290 MAIL 55 4 N. D() )tup-n
SIZE OF-LOT O It 1 V NOWOONB LOTB 1 CITY1IeMTD1? City TEL. N.. 442-1878
USE OF
BUILDINGS SincK le Family Residence DISTRICT NO. GROUP MAP ESBE D BY
A-a 4 - �
CONTRACTOR John Marshall Cons ✓Uruct1O1, 16 Q
ADDRESS P.O. Box 1232 CONNECTION DATA
CITY Areaclia TEL. NO. 286-9822 - STATION DEPTH
STATE 1.�[.Ol LIC Sl MANHOLE REFERENCE / �-
LICENSE NO, tk J 15 CLASS 3 LOWER
NO. DESCRIPTION OF WORK- FEE TYPE OF CONNECTION LEN THF M }
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P. d
PUBLIC SEWER a $3.00O
P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD JOB NO.ELD ® 310.00 CO.IMP. NO. V
HOUSESEWER C ONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, O
E.11.TE DISPOSAL SYSTEM ® 33.00
CONNECT ADDITIONAL BLDG.OR AFFIDp VIT AIV .1 RECORD.INSTR.NO. AT. (-
WORKTOHOUSESEWER ® 33.00 W
OVERFLOW SEEPAGE PIT.DRAINFIELD d
E%TN.,CESSPOOL.DRYWELL.MAN HOLE® $3.00 VI
lI �RlP}f✓COY.ABANO ON HOUSE I - ^ HWK ORST.WIDENING Z
X SEWER OR�[Br3a S TTM
3300 V/Yl`/ STATES ENCROACHMENT
PERMIT NO. �
INDUSTRIAL
WASTE APPROVAL
C ARGES
OWNERS PERMIT s z 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE E
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SE FFgR
GATE INSPECTOR'S SIGNATURE
SIGNED THIS �V DAY OF � L 19
OWNER OR V ,' ^]/�F l/ - NEW HCT ADDIWER
OWNERS AGENT J7.zr•�l.ILL� . // iL CONNECT. SEWETIOR
ADDRESS
� TG BUILDING OR WORK
SEPTIC TANK,SEEP.PITIS)
HEREBY ACKNOWLEDGE TMST I HAVE READ THIS APPLICATION pryDIOR GRAINFIELD
AND STHAT THE ABOVE ICORRECT AND AGREE TCOMPLY
WITH ALL ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
G ULw TING CESSPOOL [I DRYW ELL
- ❑
PLUMBING AND SEWERS.
IHEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLU AND
RESIDE IN. THE� BOYE DESCRIBED RESIDENTIAL/y�/1PROPERTY. ABANDON
SIGNATURE I /(� /// A BACKFILL SEPTIC TANKS Cl
OF PERMRtEE r ��✓� /' SEEP.PIT IS/ ❑ CESSPOOLS ❑
VALIDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK.
M.0. CASH '
p ._ 8531 JMl281QD 5.00
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