HomeMy Public PortalAbout9812 FLAHERTY ST_Sewer__ CE808 12-68 ,
76A 642D APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION ABUIDDLOING
LD NG
RE39 �,ZFlaherty Ste `
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY' Temple Cit
NEAREST Golden West
FOR APPLICANT TO FILL IN CROSS Sr.
LEGAL R. Bowen
DESCRIPTION LOT NO. � OWNER
�m _� MAIL 1620 Melanie Ln.
BLOCK TRACT ADDRESS
NO OF BLDGS,
SIZE OF LOT NOW ON LOT ] CITY Arcadia TEL. NO.
USE OF D
BUILDINGS Res . DISTRICT NO, GROUP MAP P G I PROCESSED BY
I BK
CONTRACTOR Square Deal Sewer Service .5.Oc ,T
ADDRESS 2933 Maxson Rd. CONNECTION DATA
CITY �1 On TEL. NO.L 44-2020 STATION �fU C� DEPTHSTATE /
LICENSE 1
ENSE NO, 28870 CLICLASS C-42 MANHOLE REFERENCE •;! / ,I.• I �i UPPER
(�J nwcw
NO. DESCRIPTION OF WORK FEE TYPE OF ION LENGTH FROM
HOUSE SEWER CONNECTING TO / p� v Y CU B• P.L. M.L TO P.L.
PUBLIC SEWER Q SS 00
SEPTIC TANK SEEPAGE PIT OR ^J P G.NO.
PITS AND/OR DRAINFIELD @ S1000 CO IMP.NO. /9 3 z .108 NO
N
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO, r
PRIVATE DISPOSAL SYSTEM $3 00 arzi_ a'
CONNECT ADDITIONAL BLDG OR Y[[I [A5[M[NT RECORD. INSTR NO. DATE U
WORK TO HOUSE SEWER Q S300
OVERFLOW SEEPAGE PIT DRAINFIELD C:)
EXTN,CESSPOOL DRYWELL.MANHOLE $500 F-
ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING C')
SEWER OR DISPOSAL SYSTEM $300
STATE ENCROACHMENT a-,n=
PERMIT NO. U
INDUSTRIAL
WASTE APPROVAL
G
OWNERS PERMIT s z 00 CHARES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE 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 INSP CTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR - NEW HOUSE SEWER
OWNERS AGENT_
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL [I DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTE D AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, fND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DES IBED_R ESIDENTIAL 7OP7 ABANDON HOUSE SEWER
SIGNATURE
OF BACKFILL SEPTIC TANKS ElPERMrTTEE
SEEP.PIT(S) ❑ CESSPOOLS E]
VALIDATION JACK R. ALLEN
M.0 CASH SUPERVISING MECHANICAL ENGINEER
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