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Home My Public Portal About4930 FIESTA AVE_Sewer__ 1 76A64 2D 0 63 APPLICATION FOR PERMIT A64LJ COUNTY OF LOS ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER 77 BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMWE County Engineer ADDRESS 0 Fiesta Ave WILLIAM A JENSEN Supt of Building Temple City LOCAL TY NEAREST FOR APPLICANT TO FILL IN CROSS ST La Rosa LEGAL DESCRIPTION LOT NO 12 OWNER C. Baldwin MAIL BLOCK TRACT 4647 ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO ML USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS � CONTRACTOR Valley PlumbingCO '�, ��', " BK PG ADDRESS 442 W, Fleetwood Place CONNECTION DATA CITY Glendora TEL NO Ed 51293 STATE STATION DEPTH MANHOLE REFERENCE UPPER REGISTRATION NO 209431 CO NTY LOWER NO DESCRIPTION OF WORK FEE I TY rOXECTION LENGTH FROM HOUSE SEWER CONNECTING TO B P L M L TO P L PUBLIC SEWER @ 35 00 �, C NO CL O SEPTIC TANK SEEPAGE PIT OR CO IMP NO OB NO PITS AND/OR DRAINFIELD @ S1000 (J HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM S3 00 1 CONNECT O ADDITIONAL BLDG OR a3 00 3 0o AFFIDAVIT WAIVER EAS[MENT RECORD INSTR NO DATE O OVERFLOW SEEPAGE PIT DRAINFIELD UW EXTN CESSPOOL DRYWELL MANHOLE @ $500 N ALTER REPAIR OR ABANDON HOUSE HWY OR 5T WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER S PERMIT 2 00 AUTHORIZATION TOTAL FEE 5 0o CONNECTIO HARGE FEE 1HAVE 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 INSPECTOR S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK G�ADDRESS SEPTIC SEPTIC TANK SEEP PIT(S) E' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL [I DRYWELL ❑ I 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 OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PITS) ❑ CESSPOOLS ❑ ALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH i rtt,o 6 1 0 0 1]HR 2 1 0 D 500 'f Y D S&E663 12 54 ■ ■APPLICATION FOR PERMI ■ 1 5&E 6 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer County of Los Angeles BUILDING O WM J FOX COUNTY ENGINEER ADDRESS r CASSATT D GRIFFIN SUP T OF 6UILDIV6 LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST LEGAL DESCRIPTION LOT NO OWNER BLOCK TRACT / ADDRESS 3a a4a r dS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY - TEL NO USE OF BUILDINGS DISTRICT 0GROUP MAP CONTRACTOR �� I B� PG 3 ADDRESS CONNECTION DATA CITY TEL NO S f 9 STATION DEPTH JJJ /�} P-ITATE MANHOLE REFERENCE REGISTRATION NO �/ ❑ COUNTY UPPER LOWER TYPE OF CONNECTION LENGTH FROM NO DESCRIPTION OF WORK FEE Y CURB P L M L TO P L HOUSE SEWER CONNECTING TO _ PUBLIC SEWER Q $ 3 50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG OR `LQ CO IMP NO JOB NO WORK TO HOUSE SEWER 1 00 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 (� " TRUNK PERMIT NO ROAD PERMIT N DISCONNEC(AND ABANDON SEWER STATF ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TANI SEEPAGE PIT OR / PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL CESSPOOL DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2 00 CHARG S CONNECTION CHARGE FEE OWNER S PERMIT $ 00 AUTHORIZATION I TOTAL FEE ,yam REIMBURSE! ENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER SIGNED THIS.¢ DAY OF NEW HOUSE SEWER A OWNER OR I CONNECT ADDITIONAL I Q OWNERS AGENT BUILDING OR WORK SEPTIC TANK SEEP PIT($) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOV DESCRIBED RESIDENTIAL PROPERTY ^ BACKFILL SEPTIC TANKS❑ SEEP PIT(S) ❑ CESSPOOLS❑ SIGNATURE / 7✓r OF PERMITTEE F1 WILLIAM J FOX COUNTY ENGINEER VALIDATION J&3 4 6 2�9 FES24 4 300 BY BY DEPUTY DEPUTY r BY BY ® DEPUTY DEPUTY