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Home My Public Portal About5304 LOMA AVE_Sewer__ TEMPLE CITY CEBOB 5.65 76A 642D APPLICATION FOR PERMIT - COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 30 JOIN A. LAMBIE, County Engineer ADDRESS COLEMAN W JENKINS,Supt o[ Building Temple City LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS 5T LEGAL DESCRIPTION LOT NO e/_ OWNER Euclid Const. , BLOCK TRACT AD DD RE55 722 Eo Valley B1. NO OF BLDGS SIZE OF LOT NOW ON LOT CITY San Gabriel TEL NO. USE OF BUILDINGS Res o DISTRICT NO GR (�[�t j - MAP /e PROCESSED BY /„G CONTRACTORY t(, ADDRESS 2933 Maxson Rd . j.� CONNECTION DATA CITY E1 Monte TEL N0444-2020 STATION / //` DEPTH`J NIOCE NSE 128 0 CLASSSE `— 2 / (/ o (` MANHOLE REFERENCE I NO DESCRIPTION OF WORK FEE TYPE=ION LENGTH ROM 1 PUOUSE SS EWER CONNECTING TO C $ 5 00 F Y CUR P L ML TOPIL SEPT IC TANK, E AGE PIT OR 00 PC NO d PITS AND/OR DRAINFIELD C $1 0 00 CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NOU PRIVATE DISPOSAL SYSTEM C $ 3 00 CONNECT ADDISTIONAL BLDG. OR AFFIDAVIT WAIVER EASEMENT RECORD IN5TR NO DATE O WORK TO MOUE SEWER P $ 3 00 R A A N H USE U SEWER OR DISPOSAL SYSTEM C $ 3 00 tL CIRAINFIELD HWY OR ST WIDENING H d E%TN ,CESSPOOL. MANHOLE C $ 5 00 STATE ENCROACHMENT z PERCOLATION TEST C $ 5.00 PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s z 00 CHARGES AUTHORIZATION TOTAL FEE 7 ,00 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 TH1$ DAY OF 19_ =n^ y OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, ND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL OPE Y. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK M O CASH 9 5 3 9 JUL 12 1 0 0 7.00- 1 10-63 76A642D ~ APPLICATION FOR PERMIT 6A64lJ COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS O WILLIAM A. JENSEN, Sup't of Building LL _ LOCALITY NEAREST FOR APPLICA=TO1LL I CROSS ST UC-C-1 /S LEGAL 'POP �r-J L Y..J dJ �J��os r DESCRIPTION LOT NO OWNER � j"f�G(JiUL> ( -✓O• r.NYV MAIL BLOCK L. TRACT /{�J ADDRESS �^� //��jj // J_NOW OON LOTS � CIT p � TEL ,NO L/ SIZE OF LOT`"/' . 'Z 1 _ USE OF BUILDINGS L U T 7 DISTRICT NO GROUP MAP PROCESSED BY A /� /C B K P/jG� CONTRACTOR C�� L.iwo "'� (j/ � i ADDRES 2CE,, - t-j CONNECTION DATA CITTEL. NO _ YO STATION DEPTH ❑ STATEUPPER REGISTRATION NO ❑ COUNTY MANHOLE ERENCE R NO DESCRIPTION OF WORK FEE TYPE OF CORt4CTION LENGTH F HOUSE SEWER CONNECTING TO - Y CURB-,_ P.L. M. L r PUBLIC SEWER @ $5 00a NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD @ S1000 CO.IMP NO 0 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO R PERMIT NO PRIVATE DISPOSAL SYSTEM $3 00 ix CONNECT ADDITIONAL BLDG OR AFFIDAV wAIV12 !AS!MINT RECORD.INS NO, DATE O WORK TO HOUSE SEWER @ $300 FT OVERFLOW SEEPAGE PIT,DRAINFIELD (� EXTN,CESSPOOL.DRYWELL,MANHOLE @ $5.00 BAN HOUSE A ^ HWY OR ST WIDENING h FJISP OSAL SYSTEM @ $300 0--p. V) STATE ENCROACHMENT Z PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 2 00 AU'T'HORIZATION TOTAL FEE I G CONNECTION CHARGE FEE CHARGES 1HAVE 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 I BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY 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 TH I AM THE LEG OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A E DES '�D ID NTI L PROPERTY. ABANDON HOUSE SEWER / 'ta'�v-7i SIGNATURE BACKFILLS PTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH LAC8409"�-aMAY 82 OD 5.00— a P — ' c� ..