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Home My Public Portal About5121 DOREEN AVE_Sewer__ TEMPLE CITY DEBDB 3.62 APPLICATION FOR PERMIT /6A892D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer. ADDRESS 121 Doreen Ave. WILLIAM A.JENSEN. Supt of Building LOCALITY TeMplA City NE.RE CROS$BST. a e_t FOR APPLICANT TO FILL IN EGAL DESCRIPTION LOT NO. OWNER — e t Co C -� MAIL 11706 Ramona Bl. BLOCK TRACT ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITYRj_ Monte TEL. NO. VSE OF _ ReQ• DIBTRICT NO. GROUP MAP PROCESSED BY BUILDINGS V BK eG 1'. CONTRACTOR ISgUare Deal Sewer Service ADDRESS 33_ iaaxson Rd. i CONNECTION DATA TEL. ND.GI 4-2020 CITY El Monte Fye{ STATE MANHOLE(RHF/ERREENCE H UPPER REGISTRATION NO.12$$ 0 COUNTY NO. DESCRIPTION OF WORK FEE TYPE OF CLENGTH FROM HOUSE SEWER CONNECTING TO Y. ON EC P.L. M.L.TO P.L. Y PV SLID SEWER Q 55.00 OO f O SEPTIC TANK.SEEPAGE PIT OR wP.C.NO. PITS AND/OR GRAINFIELD 51000 CO.IMP. NO. :0 JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Y ( O PRIVATE DISPOSAL SYSTEM ID S30° Vim/ CONNECTADDITIONAL BLDG.OR AFFIDAVIT WA5[XfX RECORD. NSTR.NO. DATE WORK T O HOUSESEWER @ 33.00 OVEPFLOW GE PIT.DRAINFIELO EXT N..CESSPOCLSEEPA.DRYWELL.M AN HOLE @ S5.00 (/r ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT PERMIT NO. ' INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE Ijr G,' AUTHORIZATION TOTAL FEE 7 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE, INSPECTOR'5 SIGNATURE SIGNED THIS DAY OF 19_ ({. OWNER OR NEW HOUSE SEWER /s/��/� OWNERS AGENTj�,� CONNECTADDITIONAL ADDRESS •.—'•• BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL El I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR LICENSED AS REEL IRE° BY LOS ANGLES COUNTY AND STATE OF I SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND NTENO TO DISCONNECT PLUG AND RESIDE IN. THE ABOVEE.RIBE PE510ENTIAL flOP T . ABANDON H OUSESEWER SIGNATURE � BA-11LL.-1ICTANKS OF PERMLTTEEEl SEEP,PIT ISI ❑ CESSPOOLS ❑ VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH uao6 0 0 5% OCT2 5 1 0 D 7.00 IN — TEMPLE CITY CEBDB 3.62 APPLICATION FOR _PERMIT 7SA6420 u COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F DINc 121 Doreen Ave. JOHN A. LAMBIE. County Enginoer Ess WILLIAM A. JENSEN. Supt of Building LITY Temple City " - EST FOR APPLICANT zTO FILL IN CROSS ST. K $a. OESCRGPTIION LOT NO./ 30` -LSt'O�ao_ OWNEfl un-D eatment Co. /� MAIL 4� BLOCK G TRACT /��/' �, ADDRESS I 1 'Io6 RamOTIa D NO. OF BLDGS. El Monte TEL. NO. SIZE OF LOT NOW ON LOT CITY USE OF ��,[[[ e DISTRICT NO, GROUP MAP PROCESSED BT BUILDINGS _ Re[! BK PG CONTRACTO6quare Deal Sewer Service ADDRESS 93 MGaxaon Rd. +�� " CONNECTION DATA CITY 9Ayty TEL. NOGI -2020 /TAT ION IqA& DEPTH ��/]]CC}�[4 Ip-.1{ STATE MANHOLE REFERENCE UPPER REGISTRATION NO.y(�o0 O Ll COUNTY NO. DESCRIPTION OF WORK FEE TYPE OF CON E f LENGTH FROM p HOUSE SEWER CONNECTING TO Y, l� / P.L. M.L TO P.L ./•/ PUBLIC SEW ER 45.00 SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. ��y�I JOB NO. O V PITS AN./OR ORAINFI ELD 410.00 �✓��` HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. �/ / 7 0 PRIVATE DISPOSAL SYSTEM @ $3.00 f CONNECT ADD ITIONAL BLDG.OR AFFIDAVIT AIYII� INSTR,NO. DATE r' WORK TO HOUSE SEWER @ S3.00 �uQJS. OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL.MA N H O LE a 55.00 (/J HWY.OR$T.WIDENING ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM $3.00 STATE E NCROACHMENT 1 Saddle 2 00 PERMIT NO. INDUSTRIAL OWNERS PERMIT WASTE APPROVAL CHARGES s AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- a�0 TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. ., APPROVALS DATE INSPECTO R'S SIGNATU RE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT NAVE READ THIS APPLIGTION 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 ❑ pRYWELL I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNT AND STATE OF 5EWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER O AND INTEND TO OISCONNECT PLUG AND RESIDE IN, THE ABOVV Fi DESCjjIBE RES IDENTIA PR ERTY. ABANDON HOUSE SEWER SIGNATURE S.p, PJ/ BACKFI LL SEPTIC TANKS ❑ OF PERMRTEE G� ❑ SEEP.PIT 151 ❑ CESSPOOLS OVALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.0. CASH LjCO6 0 0 6% OCT 25 1 1 D 2 5.00 v