HomeMy Public PortalAbout9916 HOWLAND DR_Sewer__ TEMPLE C9TY
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COUNTY OF LOS ANGELES SEWER—SEWAGE DOSPOSAL
DEPARTMENT OF COUNTY ENGINEER _.
BUILDING AND SAFETY DIVISION
BUILDING
/' y
ADDRESS 6
l " G",Jr''1/ ,�•�
JOHN A. LAMBIE, County Engineer ti
CASSATT D. GRIFFIN, Supt o4 Building LOCALITY
NEAREST _y. "�_ '
FOR APPLICANT TO FILL IN CROSS ST. a z�i J C411.1e ;
y LEGAL ...
DESCRIPTION LOT N0. c OWNMAIL
E .
BLOCK TRACT
ADDRESS -� ---,--' }
to ' '
NO.OF BLDG
SIZE OF LOT - NOW ON LOTS CITY -_�� /f—'�Cr,TTEL. NO
SEF I O "��
BUILDINGS ,/ice' r '� - DISTRICT NO. GROUP S MAP P ,SED BY
_f�J BK PG V
CONTRACTOR /.
•n.
ADDRESS,';:, CONNECTION DATA
CITYr TEL.NO ms's / STATION DEPTH
h STATE MANHOLE REFERENCE /^� UPPER
REGISTRATION N0. �(�.�r y(�l.+L�" ❑ COUNTY �'
NO. DESCRIPTION OF WORK FEE /r
a HOUSE SEWER CONNECTING TO $ - �[
PUBLIC SEWER @ $3.00 YPE OF CONNECTION LENGTH FROM Ia
SEPTIC TANK,SEEPAGE PIT OR j Y. CURB P.L. M.L.TO P.L. 7�-
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
P.C.N0.
HOUSE SEWER CONNECTING TO
I' PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
RK ADDITIONAL BLDG.OR
WORK TO ECTHOUSESWER@ $1.00
TRUNK PERMIT NO. RO ERMIT NO.
atWE- cyS�EM @-R•ERAd•R-(}R ABANDON HOUSE STATE ENCROACHMENT
k SEWER OQ n4conce .00 PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
8 CHARGES
OWNER'S PERMT $ 2 00 CONNECTION CHARGE FEE
F AUTHORIZATION TOTAL FEE 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 SEWER.
SIGNED THIS DAY OF 19_ 1' NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
y OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
ICO 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY RE ERED AND/OR DISCONNECT PLUG AND J� �j ,��pp 0,�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY A STATE OF ABANDON HOUSE SEWER _ N .Nk >_'_1' �
CALIFORNIA OR THAT 1 .AM THE LEGAL OWNER YOFT":E:ABOVE
DESCRIBED ROR TH LPROPERTY. BACKFILL SEPTIC TANKS ❑SIGNATURE �, / / SEEP. PITS) ❑ CESSPOOLSOF PERMITTE C�/`�
®" ALIDATION ROBERT A. WOOD
`4 QK
M.p CASH SUPERVISING MECHANICAL-ENGINEER
LALL 0 8 1 712 SEP30 1 0 D 5.0OM
J /
76A64 4/72 APPLICATION
PPL II/ ATION FO I�ft_RMH
76A642L F`i Loa `V II �'t7 I�lG lf'6�V�
COUNTY OF LOS ANGELES SEWER-S AGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER - -.-
BUILDING AND SAFETY DIVISION euILDINc /,b
J y'
ADDRESS /• �1��/ , •�
LOCALITY
' NEAREST NSA
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER 1�- / 'I�✓�.
MAIL R
BLOCK TRACT �► ADDRESS de� Ciel// -t
BLD
SIZE OF LOT
�/ O NOWN 0. OON LOTS -
Z CITY �•`'Ji OJe �/ TEL. NO.
USE OF 31"1 D ISTRICT N0. GROUP MAP SSEI BY
BUILDINGS 3-'C�`i-� BK PS
'V
( , ,^y 0 1
CONTRACTOR o u (�./� ) � O
ADDRESS l?q1 LcJ! tj CONNECTION Dil
r ^�/ i TATION DEPTH
CITY -e�[W{ �� TEL. NO. :)-t9
STATE LIC NHOLE REFERENCE UPPER
LICENSE NO. CLASS LOWER
NO. DESCRIPTION OF WORK FEEY. TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ >-
SEPTIC TANK.SEEPAGE PIT ORO. 0-
PITS AND/OR DRAINFIELD @ GO.IMP. NO. JOB NO. O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. U
PRIVATE DISPOSAL SYSTEM @ CA:
CONNECT A ODITIONAL B%306 eW AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR. NO. DA O
WORK TO HOUSE SEWER @ U
H
OVERFLOW SEEPAGE PIT.DRAINFIELD V
EXTN..CESSPOOL.DRYWELL.MANHOLE @ W
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING d
SEWER OR DISPOSAL SYSTEM @ STATE ENCROACHMENT h
PERMIT NO. z
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMITS O C7
AUTHORIZATION TOTAL FEE O CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING `'
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER _
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I 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 ❑
1 HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED B LOS ANGLES COUNT AND STATE OF I SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 HE LEGA O AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV D IBED I E I PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMrrTE ❑
SEEP.PITIS) ❑ CESSPOOLS
LIDATION
CK. M.0. CASH
s 0. 5* €a'221.0 D .._ . 6.000:58