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Home My Public Portal About6145 HART AVE_Sewer__ r TEMPLE CITY 78Al.tj2lh a-S cee -sa' All P U CA ll �O N FOR tl E R M f FI COUNTY OF LOS ANGELES SEWER-SEWAGE ®USP®SAL �JJ DEPARTMENT OF COUNTY ENGINEER - BUMDING AND SAFETY DMSION BUILDING ^ ' ADDRESS i JOHN A. LAMBIE. CountF Engineer CASSATT D. GRIFFIN, Supt of Building LOCALITY NEAREST a q FOR APPLICANT TO FILL IN CROSS ST. /]� LEGAL DESCRIPTION al(6 ��. �!� D OWNER LOT-N0. � - BLOCK TRACT �B MAIL ADDRESS _ NO.10F BLDGS. SIZE OF LOT v NOW ON LOT CITY TEL. NO. ' USE OF £? BUILDINGS �"(�J`. DISTRICT NO., GROUP MAP n PROCE D BPGY CONTRACTOR ADDRESS. Qj G�C h �Y J (CJJ CO[NN�ECTI�OJ DATA ' CI7Y IQ2�y a t TEL.NO. / 3 /vTION DEPTH STATE MANHOLE REF RENCE UPPER- REGISTRATION NOL COUNTY NO. DESCRIPTION OF WORK FEE GHOUSE SEWER CONNECTING TO p�' PUBLIC SEWER @ $9.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,E` PTS AND/OR DRAINFGELDT OR @ $ 00 Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT,DRAINFIELD t EXTN..CESSPOOL.DRYWELL @ 2.00 - HOUSE SEWER CONNECTING TOP.C.NO.- - PRIVATE DISPOSAL SYSTEM @ 1.00 :; CO.IMP. N0. ' JOB NO. .` CONNECT ADDITIONAL BLDG.OR I I fTRUNK PERMIT NO. ROAD PERMIT NO. �= WORK TO HOUSE SEWER @ 1.00 's ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT r'. SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. 1 - WASTE APPROVAL I CHARGES M Ovvmws PERMIT S 2 00 CONNECTION CHARGE FEE a(A r U 44 AUTHORIZATION TOTAL FEE /�.Y� REIMBURSEMENT FEE t V V_ _rI i` I'HAVE AT THIS DATE.A CONTRACT WITH THE HEREIN N MED CON- H TRACTOR TO CONNECT THE ABOVE DESCRIqfD EXIST G DWELLING APPROVA10 BATE' INSPECTOR'S SIGNATURE TO THE PUBLIC SEWIR. / SIGNED THIS" DAY OF 19fz_ NEW HOUSE SEWER 7 11V,67- ,1v ✓ F. OWNER OR CONNECT ADDITIONAL r OWNERS AGENT k BUILDING OR WORK ADDRESS "; SEPTIC TANK,SEEP.PIT(S) k`- AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL [I DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLTER,REPAIR,SEWER OR PLUMBING AND SEWERS. K SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT 1 AM PROPERLY REG TERED AND/OR ' DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES OU Y AND'STATE OF .l ABANDON HOUSE SEWER ' CALIFORNIA OR THAT 1 A T LEG L" W OF THE OVE DESCRIBED RESIDE A P BACKFILL SEPTIC TANKS C]SIGNATURE SEE PIT(S) ❑ CESSPOOLS OF PERMITTEE - d OF ALIDATION ROBERTA WOOD M.0. CASH SUPERVISING MECHANICAL ENGINEER. �_.. 1 2 9 8" JUL 9 1 0 0 7.00- 4650 INSERTS r - 6.60 7666 /rUll PLO�Y/!/'- T ®D V FOR U E II It IIVIl T - 78A642D COUNTY OF LOS ANGELES SEWER-SEWAGE WER—S2WGE ®O Sp®SA DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS /' f JOHN A. LAMBIE. County Engineer WILLIAM A. JENSEN, Supt of Building LOCALITY < _. NEAREST ANT TO FILL IN caoss sr. FORAPPLICANT / LEGAL DESCRIPTION LOT NO. f,M, OWNER BLOCK TRACT �j f MAIL - �(/ f ADDRESS 0 1 � N0.OF SLOGS. - - - SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OFDI DISTRICT NO.[GROUP MAP P CESS BUILDINGSSK PG CONTRACTO 10 l Sd496 ADDRESS /oL ,�/,,�c - CONNECTION DATA CIT! D Qf4.Q TEL.NO. //ti` �� 3 SAT N DEPTH P STATEMANHOLE REFERENCE - UPPER 7 REGISTRATION NO. �d / T�L ❑ COUNTY - NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 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 O. HOUSE SEWER CONNECTING TO -JOB C. O. PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. OB N0. W - CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. V WORK TO HOUSE SEWER @ $1.00 ALTER REPAIR DAISPOSAL SYSTEM HOUSE @ $1 00 - STATE ENCROACHMENT . ca PERMIT NO. O INDUSTRIAL _ U WASTE APPROVAL W ° CHARGES OWNERS PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE CL&2 REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE` TO THE PUBLIC SEWEfi1 . ." SIGNED THIS / DAY OF _I9� NEW HOUSE SEWER OWNER OR /A'_.-,, ) CONNECT ADDITIONAL OWNERS AGENT y/F7i'6(f�-� BUILDING OR WORK - ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I 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 I HEREBY CERTIFY THAT 1 AM PROPERLY RE ST RED AND/OR DISCONNECT PLUG AND LICENSED AS REQUI BY LOS ANGELES C N Y_ D STATE OF a - CALIFORNIA OR T E LEG N R THE AB ABANDON HOUSE SEWER DESCRIBED RESID TI P TY. BACKFILL SEPTIC TANKS ❑ - SIGNATURE SEfa.PIT(S) ❑ CESSPO S ❑ OF PERMITTE / ®r V XTION ROBERT A. WOOD c M.o. CASH. SUPERVISING MECHANICAL. ENGINEER ' L LAce 1299 9 1 1 D 2 5.00N