HomeMy Public PortalAbout6236 ENCINITA AVE_Sewer__ DI. $0.911 of S. 141.58,
-of lot- l .except E. 203? TEMPLE CITY
CEPOB'$-65 �
76A642D APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 6236 N. Encinita Ave.
JOAN A. LANIHIE. County 1':-gime[ ADDRESS
COLFAAV OV. JENMNS, SF,I'. n! Building
!LOCALITY Temple Cit
=j FOR APPLICANT TO FILL IN
=ROSSGST. on. den Ave.
LEGAL p
DESCRIPTION LOTNO. Por. Of 1 OWNER Pete Bentz
MAIL
BLOCK TRACT Santa Anita land Co. ADDRESS
6238 N. Faicinita Ave-
NO. OF SLOGS.
S1ZE OF LOT NOW ON LOT CITTemole Citv TEL. NO.
USEOF pC� DISTRICT NO. GRO}yf. MAP PRO ESS BY
BUILDINGS e a
I. PG
J `
CONTRACToRSq are Deal Sewer Service e [ O � L — /
AODRRSS 293133 Maxs on Rd. . coNNecno DATA
CITY El Monte TEL NO./'� 1� — 020LIC
ON
, DEPTH
No. SE 12[{[j 0
CLASS SSLICENSE C-42 ,?'� MgNH OLE REFERENCE / LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF ON ION LENGTH FM 1�
HOUSE SEWER CONNECTING TO M.L.TO P.J. rf
l PUBLIC SEWER f $ 5.00 00
Pi fC TANK. SEEPAGE PIT UR
PITS AND/OR GRAINFIELD @ $1 0.00 co.IMP. NO. JOB NO. d
0
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. / V
PRIVATE DISPOSAL SYSTEM C $ 3.00
CONNECT ADDITIONAL BLDG, OR AFFIDAVIT .ry [[v[ RECORD. INSTR.NO. DATE
WORK TO HOUSE SEWER G $ 3,00 .' [a u
A 4NOON NOOSE
SEWER OR DISPOSAL SYSTEM T7 $ 3.00
t�� HWT. OR ST.WIDENING
E%TN.,CESSPOOL. MANHOLE C $ 5.00 Z
$TATE ENCROACHMENT
PERCOLATION TEST $ 5.0C PERMIT NO,
INOUSTRIAL NJ
WASTE APPROVAL
CHARGES
OWNERS PERMIT s2 00
AUTHORIZATION TOTAL FEE 00 CONNECTION CHARGE FEE
'1 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 INSPEC R'S SIG NATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEW ER /J J
OWNERS AGENT -
CONNECT ADDITIONAL
BUILDING OR WORK
DRESS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANA.SEEP.F.L. T(5)
ANO�OR DgAINFIELO
AND STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEW ERE, CESSPOOL ❑ DRYW ELL ❑
HEREBY 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 I AM THE LEGAL OWN OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED RESIDE IA PROPERLY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE BACKFILLSEPTIC TANKS ❑
SEEP.Prt(S) ❑ CESSPOOLS ❑
V LIDATION
M.O. CASH
LAAO 7 4 9 9-�. MAR 8 1 0 D 7.00-
N. 80.91+ of S. 1¢1.38,
of lo-u- 1 except E. 2031 TMIPLE CITY
`6A55
T5A642D5a2D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION e.......
JOHN A. LAMRIE, C..., I:R9 DCrt! ADDRESS 62 6 nc finita Ave.
(101.1i%WN 6t. .)I:NFIN S. Suy'I. u[ B.ildinq LOCA LITY 'Cmle Cit
FOR APPLICANT TO FILL IN
CROSS ST. Longden Ave.
GA
DESCRIPTION L Pete Bentz
TION LOT NO. �, OY Of 1 OWNER
DLOCK TR4CTSanta Anita land Co. MAILgODRE55 238N. Encinita Ave.
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT CITTemnle CiLV TEL. NO,
USE OF DISTRICT NO. ROUP MAP
Res . R E55 BT
BUILDINGS
BK PG
CONTRACTOR Square Deal Sewer Service /�
ADDRESS 33 II'�iaxson Rd. LCI - / CONNECTION ATA
CITY El Monte TEL. NO. 1+44-2020 TION DEPTH
LICE
NO. NSE 1288'70 CLASSSE C-4.2
MANHOLE REFERENCE
LOWER
No DESCRIPTION OF WORK FEE TY OF CO ECT LENGTH IPOM
HOUSE.SEWER CONNECTING TO Y. M.L.TO L.
PUBLIC SEWER C $ 5.00 }
PTI TAN SEE�GE PFT Ofd- P.C.NO. y
PITE ANO/OR DRA INF IELO F $10.00 CO.IMP. NO. JOB NO. O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. / u
PRIVATE DISPOSAL SYSTEM C $ 3.00 C
CONNECT AODI I"NAL BLDG. OR AFFIDAVIT elv suENT RECORD. INSTR, NO. OAT. O
WORK TO HOUSE SEWER F $ 3.00
T * RII.Il .1 P ANOaN HOUSE
SEWER OR DISPOSAL SYSTEM C C 3.00 W
uvtmlL-6W-SEE 1ET ATITFTELD HWY.OR ST.WIDENING S
EXTN.,CESSPOOL, MANYOLE 9 $ 5.00 U1
STATE ENCROACHMENT Z
PERCOLATION TEST R $ 5.00 PERMIT NO.
1 Saddle 2J OO AL
TRIAPPROVAL
cXARc.s
OWNERS PERMIT s xz dyx p
AUTHORIZATION TOTAL FEE 25 OO CONNECTION CHARGE FEEit 1A y
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE ✓� -FI
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'5 SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER 'I
OWNERS AGENT CONNECT ADDITIONAL H��y
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION A.D/.SEPTIC TAHK,SEHEL. (5) A 1I
AND STATE THAT THE ABOVE 15
CORRECT AND AGREE TO COMPLY ANO/OR DRAINFIELO
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR //I•
LICENSED AS RECLINED BY LOS ANGLES COUNTY AND STATE OF SEWAGE UISPOSAL SYSTEM �� A
CALIFORNIA OR THAT 1 AM THE LEGAL W NENT OAL F. AND INTEND TO DISCONNECT PLUG ANO P j
RESIDE IN, THE ABOVE DESCRIBE. RESIODEROPERTY. ABANDON HOUSE SEWER C
51 OF RE -�.J� BACKFILL SEPTIC TANKS ❑
OF PERMITTEE_ �1/ ��!//
SEEP.PIT(S) ❑ CESSPOOLS ❑
\VALIDATION '
M.O, CASH
L& 7498� RPIR 811 D 25.00- 5