HomeMy Public PortalAbout4849 GLICKMAN AVE_Sewer__ D
CE808. APPLICATION FOR P RMIT �- 1
eaoa e•sa COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS ,�iF gslickn.an AVP-
CASSATT D. GRIFFIN, Sup't of Building LOCALITY TeTI P ( i t, 4
FOR APPLICANT TO FILL IN
ceossST. T,7wPr A�tlsa
LEGAL 7 ,�77t�T� titiinberL
DESCRIPTION LOT N0. OWNER Eu
BLOCKAI TRACT 10992 ADDRESSI_905Vista Ave,
NO. OF BLDGS. 7 '
SIZE OF LOT NOW ON LOT CITYS i e ra MadrerEL.NO.
USE OF
BUILDINGS 3 ,T p DII��STRIrC`TT NO. K GROUP MAP GkP
OCESSED BY
Squnrp. T) al Sewer Sery! J " � J
CONTRACTOR
e
ADDRESS 2933 Tyia;••_S Ori Rd. CONNECTION DATA _
CIT1L1 Monte TEL. N0. GI 4-2020 S7VION 9 � DEPTH
��aa ❑ STATE
REGISTRATION N0. 12 pb'JO ❑ COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO .
PUBLIC SEWER @ $3.00 c)
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FR M �}
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L. ld'
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE r 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS nAY OF 79_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
1+�-+�•� SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRY-WELL ❑
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 1 AM THE LEGAL OWN OF THE ABOVE
DESCRIBED RESIDE TIA OPE TY. BACKFILL SEPTIC TANKS [ISIGNATURE SEEP.PIT(S) CESSPOOLS[IOF PERMITTEE %�-
®� �VALMATION ROBERT A.WOOD
Cx. Y.0. CACH UPERYIi'i1NG MECHANICAL ENGINEER
<<r� oY
2 1 a 5.0 O ,
t
D
CE808- APPLICATION FOR PERMIT
eeoe-e•se COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS Glickman Ave•
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY Temple City
FOR APPLICANT TO FILL IN
CROSS ST. Azusa
LEGAL _ Winberg
DESCRIPTION LOT N0. OWNER Edw.
BLOCK TRACT 10 992 ADDRESS 0 Vista Ave.
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY EL.N0.
USE OF 3- Res .
BUILDINGS Res . DISTRICT NO. GROUP MAP PROCESSED BY
PG
CONTRACTOR uare Deal Sewer Service Q I LK
ADDRES c Rd CONNECTION DATA
CITY El Monte TEL.NO.GI _2020 S ION `'� DEPTH 951-1-
,-� STATE MANHOLE REFERENCE
REGISTRATION NO. � 2i5��]Q COUNTY OWER
No. DESCRIPTIONOFWORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FR6M
. J V
PITS AND/OR DRAINFIELD Ig $3.00 Y. CURB P.L. M.LTO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN„CESSPOOL,DRYWELL,MANHOLE Q $2.00
HOUSE SEWER CONNECTING TO ? P.C,NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. .J JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Q $1.00 PERMIT NO.
Saddle 2 00 INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE25 00 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT 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 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
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 OW OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS
SIGNATURE ❑
t S P.PIT(S) CESSPOOLS❑
�/.
OF PERMITTE12A A'ql�
®� MMATION ROBERT A.WOOD
gtt, M,p.. emit SUPERVISING MECHANICAL ENGINEER