The URL can be used to link to this page

Home My Public Portal About5415 HILTON AVE_Sewer__ it C✓�% — CE9°R 21]D ]fiA 6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING p JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J Hilt n COLEMAN W. JENKINS. SUPT. OF BUILDING Temple LEA REST yem1 1t FOR APPLICANT TO FILL IN NEAREsr (PRINT OR TYPE ONLY) CROSS ST. Oli ve yS�Jt. AL DESCRIPTION LOT NO., OWNER Syyi ht MAIL BLOCK TRACT 3 AODRE55 1 NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY EL. NO. LEE OF BUILDINGS DISTRICT N0. GROUP CLASS VAP BK p PROCESSED BY S 5 j fONTR4CTOR S uare Deal Sewer Service � It W,YV ADDRESS2933—Maxsnn Rd _ CONNECTION DATA CITY El MonS TATEotee TEL. NO, 4 STATION J DEPTH LIC LICENSE NO. 1.LVV Q CLASS C-42 MANHOLE REFERENCEV i[ L� NO, DESCRIPTION OF WORK FEE YpE OF CONNECTION ll LENGTHFRO HOUSE SEWER CONNECTING TO K CUflB P,L, -L ,-EL PUBLIC SEWER SEPTIC TANK.SEEPAGE PIT OR IMP. NO. BOB NO. PITS AND/OP GRAINFIELD � E10.00 CO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM S3.00 d CONNECT ADDITIONAL BLDG.OR AFFIDAVIT Ary u2[n[Ni RECORD. NSTR. NO. DATE Q WORK TO HOUSE SEWER S5.00 v OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL,MANNOLE a 55.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING O EW R OR 015POSAL YSTEM 0 S 00 STATE V ENCROACHMENT PERMIT NO. I{I NOUSTRIAL N ��[}�{� (� WASTE APPROVAL Z OSSlilR,a PER S DO CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE / A IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMSURSE E T FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING (I' TO THE PUBLIC 5EWER. OVAL DATE INSPECTOR'S SIG AT RE SIGNED THIS DAY OF-19— OWNER F19_OWNER OR NEW OU E E IQ A OW NERS AGENT CONEC OINAL ADDRESS BU LOIN OR WORN SEPTIC TANK.SEEP,PtT(S) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR.SEWER OR LICENSEO AS REOUIRED BY LOS ANGLES COUNTY A O STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM THE LEGAL OWNER OF. A D INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL P PERTY, DISCABANONNECT HOUSE SEWER SIGNATURE %fl OF PERMETTEE BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CESSPOOLS ❑ �- VALIDATION JACK R. ALLEN DK. M.D. CASH SUPERVISING MECHANICAL ENGINEER � l,o " 5 1 9r AUG16 1 0 D 1 0.00^' TEMPLE CITY CES 08 APPLICATION FOR PERMIT ]6.A 642D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION B UILD � N. JOHN A. LAMBIE. COUNTY ENGINEER Ave. COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY FOR(PRINT OR NT TO FILL IN (PRINT OR TYPE ONLY) LEGAL olive St. DESCRIPTION LOT NO.BLOCK TRACT 8.-24 0 NO, OF BLDG$. SI2E OF LOT NOW ON LOT CITY Arr,.qt9iqTEL. NO. USE OF pISTR ICT NO. GgOUP f.LA55 IdAP flOCE55 D Y BUILDINGS BN _P7S CONTRACTORSquare Deal Sewer 1 J ADDRESS 2933 Maxson Rd. CONNECTION DATA 11 '�' J 7 L 1 me 444-2020 STATION % / DEPTH V CITY o o TEL. NO, f ATE LICENSE NO, 1.28870 0 CLA55 _42 MANHOLE REFERENCE / J�� ± IV LOWER NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTIONP.L. LENGTH FROM ^fr 1 HOUSE SEWER CONNECTING TO Y. CURB M.L.TOFL _J!/ PUBLIC SEWER Si00 SEPTIC LANK.5EEPAGE PIT ORFy01l. PITS ANO/OR GRAINFIELD SIO,00 CO. I.E. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, d PRIVATE DISPOSAL SYSTEM ® 53.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT wAll. A5enu RECORD.INSTR.NO, DATE U WORK TO HOUSE SEWER ® $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD K EXTN..CE551OOL,DRYWELL.MANHOLE® 35.00 HWY.Oq$T.WIDENING O ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM B 83.00 STATE ENCROACHMENT W PERMIT NO. d INDUSTRIAL N WASTE APPROVAL Z CHARGES OWNER$ PERMIT s o0 AUTHORIZATION TOTAL FEE 1.O OO CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER, DA79 INSP CTORSSIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER ldlfib OW NERSAGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.1ITI51 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑ IHEREBY 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 OWNER F. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE DESCRIBED RESIDENT AL PR ERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC T4NK5 ❑ OF PERMRTE ❑ SEEP.PIT(S) ❑ CESSPOO45 I VALIDATION JACK R. ALLEN cK. M.D, CASH SUPERVISING MECHANICAL ENGINEER i ilra � G Inc 19 1 c) D 1 0.00—