HomeMy Public PortalAbout5020 FIESTA AVE_Sewer__ D
5&E-6637f•55 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 5020 Fiesta Ave,
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN CROSS ST.
LA Rn®a Ilro
LEGAL �f OWNER Douglae So Longacre
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT - .13 3 �� ADDRESS 5020 Vi ests Ave
NO.OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT N0. GROUP MAP
BUILDINGS BK PG
CONTRACTORSquare Deal Sewer Service
ADDRESS
X933 M&gson Rd® CONNECTION DATA
/
STATION 14--1 [ o"5 DEPTH
CITY EZ MOY1t® TEL. NO. FQ =2020 MANHOLE REFERENCE `��+ S ` UPPER
STATE �� `" SOL( yTn>
REGISTRATION NO. 128870
No. DESCRIPTION OF WORK FEE
C -
x HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. TO P,L.
1
PUBLIC SEWER @ $3.50 YTYPE OF TION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD a $3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2,00 CO. IMP. NO. 9 JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PFR•W1-T_NO.
r CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE 415o
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPE�TOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRjj3ED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS D OF 19 CONNECT ADDITIONAL 4
OWNER OR BUILDING OR WORK
,. OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
" ADDRESS U 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 CT PLUGHOUSE AND
CALIFORNIA OR THAT I A&I THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEP❑ CESSPOOLS "I '� / r 11 •�A ;...-
SIGNATURE 61
OF PERMITTEE v
JOHN A. LAMBIE, COUNTY ENGINEER I� ALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
C. l� M.0. CASH
L AC04 6 8 4 APR 2 Q .5 '�