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Home My Public Portal About10839 GRAND AVE_Sewer__ CEAAPPLICATION FOR PERMIT �sg642D sa2D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FA JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building FOR APPLICANT TO FILL IN CS ST. ��`W /¢t Y LEGAL �O DESCRIPTION LOT NO. OWNER OMAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP BM MAP J/ PROCESSED BY CONTRACTOR77f K pG 419 ADDRESS 7.147 Lt/j.3 fh CONNEC ON DATA CITY 0% 4 I" TEL. NO. STATION / DEPTH TATE—REGISTRATION NO. �J COUNTY MANHOLE REFERENCE �L UPPER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION ENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. d PUBLIC SEWER @ $5.00 P.C.NO. O SEPTIC TANK.SEEPAGE PIT OR CO.I PITS AND/OR DRAINFIELD @ $10.00 MP•NO. .1OB NO. V HOUSE SEWER CONNECTING TO TR K ' ROAD PERMIT NO. O PRIVATE DISPOSAL SYSTEM $3.00 }}0 CONNECT ADDITIONAL BLDG.OR �^ AF IDAf I WAIVIE4 I EASEMENT RECORD.INST NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $5.00 H OR ST.WIDENING `L ALTER.REPAIR OR ABANDON HOUSE _ SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCR ENT04 40 oe PERMIT NO. INDUSTRIAL WASTE APPROVAL "- OWNER'S PERMIT $ z 00 CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 70 THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ s CONNECT ADDITIONAL ,i� -•p'. ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) 1 HEREBY 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 ❑ DRYWELL ElI 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 OWN OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO D RESIDE AL PROPERTY. ABANDON HOUSE SEWER SIGNATURE �•V) BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD -VM.O. CASH SUPERVISING MECHANICAL ENGINEER CK. { //I.� 1_ D S&E-663 11.55 APPLICATION FOR PERMIT 1 S&E•6 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 4:9839 Grand Ave. T) CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Temple City 3� FOR APPLICALNT TO FILL IN CROSS ST. Dalvview LEGAL DESCRIPTION LOT NO. ,Z ,J Y'7 /� OWNER W,H, Campbell BLOCK TRACT / q 0/L L/ MAIL ADDRESS 9409 @live NO. OF BLDGS. l CITY � TEL. NO. SIZE OF LOT NOW ON LOT USE OF BUILDINGS Res. DISTRICT N0. GROUP MAP CONTRACTOR Square Deal Sewer Service ��PIs— CONNECTION DATA ADDRESS29'33 MaXSOn Rd. CITY TEL. NO. GI 4-?020 STATION �7 q. (n DEPTH El Monte MANHOLE REFERENCE I PP REGISTRATION NO. C_42 128870 1❑ STATErY _ aCONTER NO.1 DESCRIPTION WORK FEE TYPE OF CONNECTIOLENGTH FROM 1 HOUSE SEWER CONNECTING TO Y. CURB L.N M.L. TO P.L. PUBLIC SEWER @ $3.50 3 150 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD {' P. C. NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP. NO. /� � 10B NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 _TRUNK PERMIT NO. ROAD PERMIT NO. 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 . rofQ REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE — I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORS SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THISY OF CONNECT ADDITIONAL OWNER OR /� 71 -BUILDING OR WORK OWNERS AGEN SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 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 IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ND DISCONNECT PLUG AND STATE OF ABANDON HOUSE SEWER D CALIFORNIA OR THAT I AM THE LEGAL OWNER F THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE SEEP.-PIT(S) ❑ CESSP OLS❑ - OF PERMITTEE / _. i/- ✓' C JOHN A. LAMBIE, COUNTY ENGINEERC.- LIDATION ROBERT A. WOOD. C EF PLEIG. INSPECTOR N.O. CASH 2 2 6 1 S ,025 4 A 4.50 ;°