HomeMy Public PortalAbout5125 DOREEN AVE_Sewer__ TWPLE CITY
CEBOB 3.62 APPLICATION FOR PERMIT {�
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /I
JOHN A. LAMSIE, County Engineer ADDRESS G1' 5__n=e8n--X
WILLIAM A. JENSEN, Supt QI Building LOCALITY m�hlTHe 1.Vlfl�llgC_�.�/-it
NEAREST
FOR APPLICANT TO FML IN Rp55 5T.
DESCRIPTION LOT NO.I/ J N3O �.��•tSlPd�zp OWNER Tam—nee Investment Ca.
MAIL
BLOCK TRA
11706 Ramona Bl.
C CT ADDRESS
NO. OF BLOGS.
SIZE OF LOT NOW ON LOT CITY El MontsTEL. NO.
USE
DINGSC DISTRICT NO.1 GROUP I MAP PROCESSED BY
eaa-p 0 I BK PG
CONTRACTOR tguare Deal Sewer Service
ADDRESS �(�'3'; pgaXAOT Rd - Li_CONNECTION DATA
CITRI MAme TEL. NO. "_ STATION G , DEPTH
Epi, STATE MANHOLE REFERENCE A UPPER w
REGISTRATION NO. $70 H COUNTY
N /
O. DESCRIPTION OF 4 FEE TYP FCON E N LENGTH FROM +l
HOUSE SEWER CONNECTING TO �.f.L M.L.TO P.L. (T�
PUBLIC SEWER ® $5.00 5 _ �—G✓� `✓ O
P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR
PITS AIN./.RGRAINFIELD 510.00 CO.IMP.NO, JOB NO. V
HOUSE SEWER CONNECTING TO I TRUNK PERMIT NO. ROAD PERMIT NO. /
PRIVATE DISPOSAL SYSTEM E3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 11� 5[N[N RECORD. INSTR.N°. °ATE
WORK TO HOUSE SEWER ® ".00
OVERFLOW SEEPAGE PIT.DRAINFIELD
E%TN.,CEESPOOL.DRYWELL.MANHOLE 0 SS.00
ALTER.REPAIR OR ABANDON H OUSE �. HWY.OR ST.WIDENING
SEWER OR 015POSAL SYSTEM nB 53.00 STATE ENCROACHMENT
PERM IT NO,
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE V
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
T PACTOR
ON-TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS ATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ CONN
ECT ADDITIONAL
���1��{ r
ADDRESB 1YLYY BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READTHIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AN° AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYW ELL El
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER, REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY ND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT IAM THE LEGAL OWNER OF. ND INTEND TO DISCONNECT PLUG AND
RE510E
N. THE ABOVE DESCRIBED NES IDENTIAL OR Y. ABANDON HOUSE SEWER
SIGNATUREBACKFILL SEPTIC TANKS ❑
OF PERMITTEE" ❑
i ❑
SEEP.PIT 15) CESSPOOLS
OVALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK.
M.0. CASH
Ljjo 6 0 0 7% OCT 25 1 0 D 7.0 0,
TEMPLE CITY
CESOB 3.63 APPLICATION FOR PERMIT
TfiA6C2D u
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION BUILol NO
JOHN A, LAMBIE, County Engines, D-oree
WILLIAM A. JENSEN. Supt of Building
LOCALITY }e—City
NEAREST
FOR APPLICANT TO FILL IN `ROSS ST88U.
DESCPGPTION LOT ND.�9'ry3O/�..�g` sy � OWNER L n-Lee Investment Co.
AA'L
/� /iZ 9z4 MAIL
BLOCK TRACT 11706 Ramona B1.
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY R1 MonteTEL. NO.
VSE OF I
BUILDINGS Rae, DIST/RIOT NBO. GROVP BK MAP PG PROCESSED BY
CONTPACTOR gqua a-_Deal Sewer Service �`1 �, 1i
ADOREss 2833__ aXaon Rd. CONNECTION DATA
CITY q TEL. NO. ��{`���(��� S TION _ ut' DEPTH
Ll STO ATEMANHOLE REFERENCEG / UPPER v
REGISTRATION NO, 12.$$70 El COUNTY . 1 WWF
NO. DESCRIPTION OF WORK FEE TYPE OFC N ON LENGTH FROM
HOUSE SEWER CONNECSING TO Y. P.L. M.L TO P.L.
PUBLIC SEWER ® SS.00 O
SEPTIC TANK,SEEPAGE PIT OR '7
PITS ANO/OR DRAINFIELD ® SIOOO CO.IMP. NO. '7 / JOB NO. V
HOU SE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.�j \�� O
PRIVATE DISPOSAL SYSTEM 53.00 O
CONNECT ADDITIONAL BLOC-OR AFFIDAVITW elvLx IA5E"tlT RECORD,IN5TR.N0, DATE
WORK TO HOUSE SEWER ® S3O.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE55.00 1�
ALTER,REPAIq OR ABANDON HOUSE HWY.OR ST.WIDENING Z
_ SEWER OR DISPOSAL SYSTEM 53.00 STATE ENCROACHMENT
Saddle 25. 00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $
AUTHORIZATION TOTAL FEE 2 CONNECTION CHARGE FEE
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- 600
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - APPROVALS DATE INSPECTOR SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OW NERIPAGENT_ CONNECT ADDITIONAL
nw BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP,PIT(51
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 COPRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AMC STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL -1ORYWELL
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/Oft ALTER,REPAI. SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. ND IN ND TO DISCONNECT PLO. AND
RESIDE IN, THE ABOVE D CRIB RESIDENTIAL OPER ABANDON HOUSE SEWER
SIGNATURE ❑
OF PERMITTE� BACKFILL SEPTIC TANKS
SEEP.PIT 13) ❑ CESSPOOLS ❑
OVALIDATION ROBERT WOOD
cK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
LACO6008!1: OCT 2511 0 25.00-