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HomeMy Public PortalAbout4936 HELEO AVE_Sewer__ ! TEMPLE CITY 7686421)a. A Il II L O�J!/ T�©Il V FOR p E R 11 V II�T ceeoa eae COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION aooae sG 10HN A. LAMBIE, County Engineer CASSATT D. GRIFFIN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FI CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER ,/y �• t/ ' - BLOCK TRACT r �•• ✓ MAIL r y ` ADDRESS ef;;;�/NO,OF BL GS. I —� •y/�,� �r_.� SIZE OF LOT NOW ON LOT �, CITY ` 'Y's 4s STEL. NO. USE OF c4 BUIUSE NGS••�_/ /- /' 9 DDIISSTRICT(xjN9 GR/OUP MAP PROCE D BY CONTRACTOR" 31 rJ��V J� I BK PG I ADDRESS j �= r' CONNECTION DATA T L.NO., T TIONDEPTH / STATE MANHOLE REFERENCE - REGISTRATION NO. �C:.�r%%t��1` 7 ❑ COUNTY LOWER NO. DESCRIPTION OF WORK FEE a HOUSE SEWER CONNECTING To PUBLIC SEWER' @� r•-� �' ��_���111 TYP 0 W97ECTION LENGTH FROM - - SEPTIC TANK,SEEPAGE PIT OR �, H4B� P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EX N..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 r` CO.IMP. NO. JOB NO. CONNECT ADDITIONAL BLDG.OR - TRUNK PERMIT NO. ROAD ERMIT N0. WORK TO HOUSE SEWER @ $1TA— .00 ALTER,REPAIR OR ABANDON HOUSE STATE EN OA HM r SEWER OR DISPOSAL SYSTEM @ $1.00. PERMIT e INDU51RIAL WASTE APPROVAL s CHARGES OWNER'S PERMT $ 2 00 CONNECTION CHARGE FEE ' AUTHORIZATION TOTAL FEE �;_e REIMBURSEMENT FEE I ,,I1 HAVE AT THIS DATE A CONTRACT WITH THE HEREINAMED CON- .- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIAG DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. _ SIGNED THIS DAY OF 19_ NEW HOUSE SEWER l(G AYL OWNER OR CONNECT ADDITIONAL 4 OWNERS AGENT • BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION a * AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY a 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 L^(IM THE LEGAL NE"F THE ABOVE f DESCRIBED RESIDENT 1- P OPERTY. r BACKFILL SEPTIC TANKS ❑ 'u SEEP.PIT(S) ❑ CESSPOOLS SIGNATURE ///RR+�..�� OF PERMITTE �,r Or _ VALIDATION ROBERT A. WOOD cK N.0. CASH SUPERVISING MECHANICAL ENGINEER x.9':9:•5 0G .SEP 10 1 0 D -aQ:: ^` t TEZ.MF LE CITY CES08626.59 APPLICATION FOR PERMIT - - COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, Couatg EaQiaeer DDRESS CASSATT D. GRIFFIN, Supt of Building OCALITY A EST FOR APP M� ANT TO FILL CR ST. DESCRGLEAL PTION LOT NO. /r�' . �� �" WNER- Z BLOCK TRACT !i r i d _ ADDRESS,-! �. NO.OF BL S. " ^ SIZE OF LOT NOW ON LOT CITYU SE OF BUILDINGSDISTRICT NO. GROUP MAP PROCE DiBY BK PG / CONTRACTOR r i �.Y 'r C"/' ", 9✓ - ^ O t_, ..J' / IN ALL/ ADDRESS,,, `- % 2 �. CONNECTION DATA CITY -�/.; - TEL.NO. S ATION DEPTH 3 - H/STATE MANHOLE REFERENCE - G REGISTRATION N0. L "%-,` COUNTY ZLOWER No. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE 0 C NClN LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR �4 ,L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP.C. N0. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT N WORK TO HOUSE SEWER @ $1.00 3r- • ALTER,REPAIR OR ABANDON HOUSE STATE ENCR91KCHMFNT EWER OR DISPOSAL SYSTEM @ $1.00 PERMIT ) INDUSTRIAL WASTE APPROVAL CHARGES OWkEWS PERMIT S CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE L'Z/ REIMBURSEMENT FEE CON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTDATE A CONTRACT WITH THE IINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE ',U THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER '�f"'i�', j. OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR-DRAIN IELD 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 PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES OU ND STATE OF ABANDON HOUSE SEWER CALIFORNIA ES THA'[. I PRO THE LEGAL YyNER ?!),-THE ABOVE BACKFILL SEPTIC TANKS ❑ DESCRIBED RESIDEN AL PROPERTY. - j � SIGNATURE r SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMITTEE I� / ��� ®■ ��(AIMATION ROBERT A. WOOD U.o. cAsn SUPERVISING MECHANICAL ENGINEER Vat�o 9 9 5 1 SEP 10 1 2 D 2 5 L O-