HomeMy Public PortalAbout10512 FREER ST_Sewer__ TEMPLE CITY
76A94211
CE908 8.89 APPLICATION FOR PERMIT - -
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING-AND SAFETY DIVISION BUILDING /
ADDRESS / `,i �- s 7 v
JOHN A. LAMBIE, CountF Engineer ---�-�
CASSATT D. GRIFFIN, Sup t of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cROSs IS T..'
LEGAL
DESCRIPTION LOT NO. 1` X-!� -'q7 '.�� / ''� OWNER
BLOCK TRACT J :� i MAIL
/�.--- � ADDRESS �/�16--; •/��NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY �� r%���f L,.- = EL. NO.
USE OF ,+
BUILDINGS .y�r /��. -�" DISTRICT NO. GROUP MAP I PROCESSED BY
/j BK PG
CONTRACTOR , �c✓�,%'
ADDRESS,,�'" .r e�%y` � CONNECTION DATA
CIT!:2 TELNO
. ., �=���'J STATION PT /11LIv � / c,f
T STATE MANHOLE REFERENCE
REGISTRATION NO. � � ❑ COUNTY OWE
t NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @. 3.00 . 5 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CU B P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 - CO. IMP. NO. JOB NO.
WORCONNECT K TO HOUSEISEWERBLDG.OR @ $1 OO TRUNK PERMIT N0. ROAD PERMIT N 7 9
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APIAl/
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE !- rd t:z REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREINAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATES INSPECTOR'S SIGNATURE,
TO THE PUBLIC SEWER. -
SIGNED THIS AY O 19- NEW HOUSE SEWER
OWNER OR , CONNECT ADDITIONAL
OWNERS AGENT ! BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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
1 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 LE R OF THE ABOV
DESCRIBED RESIDEN A� PROPERTY. BACKFILL SEPTIC TANKS El
SEEP. PIT(S) E3CESSPOOLS ❑
OF PERMITTE ��
OF YPiLIROBERT A. wooer
M.
0.
CIL CASH SUPERVISING MECHANICAL. ENGINEER
','&-s=o 5Q AM12 1 0 0 7.00 - 1
TEMPLE CHT
E808 D
CAPPLICATION FOR PERMIT
esoe e•se COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 7NEAREST
r� _
ILDING
JOHN A. LAMBIE, County Engineer y
- &�—
CASSATT D. GRIFFIN, Supt of Building
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL r ✓ s ��
DESCRIPTION LOT NO. �? G'�` �� OWNER �fl-';�f
BLOCK „ MAIL
TRACT > �� ADDRESS j ��: ;�� �"s��/ �±..�f
N0.OF BLDGS. �l�" ,r � /
SIZE OF LOT NOW ON LOT CITY // 11� E.L. N0.
USE DI `r DISTRICT NO. GROUP MAP CES ED BY
BUILDINGS BK' PG
CONTRACTOR
s J arm
ADDRESS�*' CO NECTION DATA
CITY TEL.N0. _ r STATION DEPTH A�I�
✓�� � —Gid ,` 12 {-o
STATE MANHOLE REFERENCE
REGISTRATION NO. COUNTY &W &,ZLOWEV
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @' '8e °L TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR - Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.NO. JOB NO. p
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N0�? //
WORK TO HOUSE SEWER @ $1 00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACH NT
SEWER OR DISPOSA SY M @ $1.00 PERMIT NO.
INDUSTRIAL V
WASTE APPR
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT S DATE A CONTRACT WITH THE Hdvf'-f�c
TRACTOR TO CIONNECT THE ABOVE DESCRIBED E TING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
LI
ED THIS DAY/ 19— NEW HOUSE SEWER
OR CONNECT ADDITIONAL
RS AGENT •r BUILDING OR WORK
SS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
REBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
ING AND SEWERS. SEWAGE DISPOSAL SYSTEM
EREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
SED AS REQUIRED BY LOS ANGELES Y AND STATE OFABANDON HOUSE SEWER
ORNIA OR THAT, AM THE LEG OWNER F THE ABOVEIBED RESIDEN.PAL ROPERTY BACKFILLSEPTIC TANKSTURESEEP.PITS) ❑ CESSPOOLSERMITTE
®" VALIDATION ROBERT A. WOOD
AL1' Y 0. CASH SUPERVISING MECHANICAL, ENGINEER
8,"8-0,6Q AM12 i I' D 25 ON