HomeMy Public PortalAbout9173 JAYLEE DR_Sewer_5/25/1966_sewer connection TEMPLE CITY
6A64 10-63 APPLICATION FOR PERM] IT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer9173 E,
ADDRESS a Dr o
WILLIAM A. JENSEN, Supt of Building
LOCALITY Temple Gity
_. . FOR APPLICANT NEARS T
T TO FILL IN CROSS'S T. Loma Ave e
LEGAL Richard Kendall
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT 14396 -
ADDRESS 9 73 E. Jaylee- Dro
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY Temple (7
Cit TEL. NO.
USE OF ; DISTRICT NO. GROUP MAP P O SSED BY
BUILDINGS BK PGG /1
CONTRACTOR qcjjijre Denl Sewer Service 'q/ " 2
ADDRESS 2§33 Maxs on Rd. n n /CONNECTION DATA
' CITY El Monte TEL. NO. I+.44-2020 STATION � � DEPTH
+, REGISTRATION NO. ❑ STATECOUNY MANHOLE REFERENCE / LOWER
NO, DESCRIPTION OF WORK FEE TYPE OF CONNECT LENGTH F OM
1 HOUSE SEWER SEW ER CONNECTING TO $5.00 5 00 Y CURB P.L. TOP }
PUBLIC
SEPTIC TANK,SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO, O
V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM 53.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE O
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD LU
V U
EXTN.,CESSPOOL,DRYWELL.MA NH OLE C $5.00d.
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING h
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00
r AUTHORIZATION TOTAL FEE 00 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
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER '� 'p'vT�gz':•^i..r+*
OWNERS AGENT CONNECT ADDITIONAL f
BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP,PIT(S)
1 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 ❑
I HEREBY CERTIFY THAT 1 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 OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE ELI ABOVE DESCRIBED RESIDENTIAL OPERTY. ABANDON HOUSE SEWER
SIGNATURE �, ❑ > +
OF PERMITTEE - BACKFILL SEPTIC TANKS fjl�p ,I
SEEP,PIT(S) ❑ CESSPOOLS may+ 3 41 1 h'�ae�.-
ALIDATION RIOBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
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