HomeMy Public PortalAbout8817 ELM AVE_Sewer__ 76A64 t) QII PLS CA B M V FOR PERMIl
COUNTY OF LOS ANGELES SEWER—SEWAGE MSPO AL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 88�7 �,* Elm A, LAMBIE, Countp Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building_ LOCALITY Temple City
NEAREST
FOR APPLICANT TO F l IN CROSS ST. Muscatel
LEGAL
DESCRIPTION. NO. r/ .l + 50
I ,5- a OWNER Charles McFall.
BLOCK T CT , A DRMAIL ESS 8811 E* Elm
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT l CITY Te le CitY TEL. N0. AT-6-4o28
USE OF
BUILDINGS Dwe111n P DISTRICT N0.I GROUP BK PG MAP OCESSED BY
CONTRACTOR Andrews Plumbing Co. /
ADDRESS 5391 Poplar Blvd* CONNECTION DATA
CITY Los Angeles TEL.N0. 223-2590 STATION DEPTH
REGISTRATION NO. 215913 STATE MANHOLE REFERENCE �� UPPER
COUNTY
No. I DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING To
PUBLIC SEWER $3.0 I TYPE OF CONNECTION LENGTH FROM
SEPTIC
TS AND/ORD AEINFIIELDT OR @ 8 0 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD %' }
EXTN..CESSPOOL.DRYWELL @ $ 00 d
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $ . 0 CO.IMP. NO. JOB NO. �' V
1 T ADDITIONAL BLDG.OR 3 QQ TRUNK PERMIT NO. ROAD PERidIT N0.
0 HOUSE SEWER 1. ix
SEWER OR DIISPOSAL SYSTEM HOUSE @ $1 O STATE ENCROACHMENT -
PERMIT N0.
INDUSTRIALW
WASTE APPROVAL d
N
CHARGES z
OWNEWS PERMIT $ .2 00 CO ECTION CHARGE FEE
AUTHOMAnON1 TOTAL FEE REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE HAVE AT THIS DATE A CONTRACT E CRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. (.,�
SIGNED THIS 5th DAY OF February 19 65 NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL �,./� z� //�
OWNERS AGENT BUILDING OR WORK 1' SLG
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT t' HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR T AT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED REST TIAL PROPERTY. , r BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S ❑ CESSPOOLS
OF PERMITTE
V ATION ROBERT A. WOOD
CIL U.o. CASH SUPERVISING MECHANICAL ENGINEER
L�' c 3 3
4 Fa 8 1 0 a 5.00-