HomeMy Public PortalAbout9928 LIVE OAK AVE_Sewer__ TEMPLE CITY
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Ceeos s-se APPLICATION FOR PERMIT ,
COUNTY OF LOS ANGELESSEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDING pp
ADDRESS 2U Live/7O
.JOHN A. LAMBM. County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER Marian BrOZ
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO OF BLDGS. '
SIZE OF LOT NOW ON LOT CIT L NO.
USE eS1 ence
BUILDINGS DISTRICT NO. GROUP MAP PR ESSED BY
BK PG+
CONTRACTOR , e M. Construction `6-3
ADDRESS 5136 No Bleecker
n CONNECTION DATA
ciTxBaldwin Park TEL No. ED 8-3q24 STATION x-00 DEPTH /,Z,
13613 STATE MANHOLE REFERENCE E
REGISTRATION NO. COUNTY > LOWER
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO (.J�
PUBLIC SEWER @ $3 00TYPE OF CONNECTION --LENGTH FROM Q
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
HOUSE SEWER CONNECTING TOP.C.NO."
PRIVATE DISPOSAL SYSTEM @ $100 CO IMP NO. /-3 O JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO, ROAD PERMIT N0.
WORK TO HOUSE SEWER @ S1 00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE' ^/O ow
TRACTOR TO CONNECT THE ABO EHAVE AT THIS DATE A CONTRACT DESCRIBED EXISTWITH THE I+NGAMED DWELLING APPROVALS /,DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF U 19 NEW HOUSE SEWER
OWNER OR
OWNERS AGENT ,,pp
6�/u:C-ul CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
1 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES CO Y AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL F THE ABOVE _
DESCRIBED RESIDENTI ROPE T BACKFILL SEPTIC TANKS ❑
P.PITS) ❑ CESSPOOLS ❑
SIGNATURE G/
OF-PERMITTE
®F / L ROBERT WOOD
pt,.0.p• CASH SUPERVISING MECHANICAL ENGINEER
J�.�) �
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