HomeMy Public PortalAbout9646 LEMON AVE_Sewer__ 4 •p0
76A :40 - 6'EBOB - 9/73 APPLICATION FOR PERMIT
' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BU
ADDRESS BUILDING 9646 E. Lemon Ave.
LOCALITY Temple City
NEAREST
FOR APPLICANT TO FILL IN CROSS ST
LEAL
DESCRIPTION LOT NO OWNER Jones % Rosemead Const.
MAIL 8
BLOCK TRACT ADDRESS 101 San Gabriel Blvd,
SIZE OF LOT
NOWOON LOTb CITY San Gabriel TEL NO. 573-4110
USE OF
BUILDINGS DISTRICTNO I GROUP MAP PROCESSED BY
BK P3
CONTRACTOR ng
Y�
ADDRESS 42,65 N. Baldwin Ave v CONNECTI N DATA
CITY El Monte TEL NO 443-0078 STATION 6 1 DEPTH Z
STATE 2�1 7�M1 LIC C`j 20 UPPER
i MANHOLE REFERENCE /4 .Z CLOWERV
LICENSE NO GLASS o'Y
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO D O Y CURB P L M L TO P L 25-
PUBLIC SEWER .00HIL
SEPTIC TANK SEEPAGE PIT OR P C NO
PITS AND/OR DRAINFIELD f l0 o0 CO IMP NO �+ 0 Z- .108 NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER [ASENKHT RECORD INSTR NO DATE
WORK TO HOUSE SEWER S300 LL
OVERFLOW SEEPAGE PIT DRAINFIELD
U
E%TN CESSPOOLABA ELL S500 HWY OR ST WIDENING
ALTER REPAIR OR ABANDON HOUSE �
SEWER OR DISPOSAL SYSTEM $3 00 STATE ENCROACHMENT
MANHOLE $7.00 PERMIT NO LU
III
NDUSTRIAL co
WASTE APPROVAL Z
CHARGES
OWNERS PERMITs o0
CONNECTIO HARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITHREIN NAMED CON. REIMBU EMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCXISTING DWELLING
TO THE PUBLIC SEWERAPPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF _19—
OWNER
9_
OWNER OR NEW HOUSE SEWER 12
OWNERS AGENTCONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVETH 1S APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND AWS REGULATINGPLUMBING AND SEWERSCESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT 1 AM PROPEGI ERED AND/OR ALTER,REPAIR SEWER OR
LICENSED AS REQUIRE BY LOS ANGLET NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFCd7N1A OR THAT AM TH GAL ONO INTEND TO DISCONNECT PLUG ANRESIDE IN, THE AS E DES RESiP PERT ABANDON HOUSE SEWER
SIGNATUREBACKFILLSEPTIC TANKS ❑OF PERMTTTEE `•C�JJJSEEP PITfS) ❑ CESSPOOLS ❑ '
1
VALIDATION K M.0. CASH
0 Nt
O 0 0'
O O O 0 _
UI 'oO '01
Co Qp - Q
O O O
CH
CEBOBAPPLICATION FOR PERMIT
78A842D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL I--I
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W JENKINS. SUP T OF BUILDING y '
LOCALITY NEAREST
FOR APPLICANT TO FILL IN
CROSS 9T
LEGAL ✓ L
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT ADDRE
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITYhl�TEL NO
USE OF
BUILDINGS DISTRICT N"GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
ADDRESS COEvCTION DATA
STATION �/"^ l DEPTH
CITY L TEL NO
STATE j .r LIC MANHOLE REFERENCE / UPPER
LICENSE N CLASS t
NO DtSCRIPTION OF'WORK FEE TYPE OFC TION LENGTH FR "�
HOUSE SEWER CONNECTING TO FJ Y CURB P L M L TOP a
PUBLIC SEWER @ $5 00 _ c � PC NO
SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO O
PITS AND/OR DRAINFIELD fI0 00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO ��
PRIVATE DISPOSAL SYSTEM @ 33 00 O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $300 IJ
OVERFLOW SEEPAGE PIT DRAINFIELD IJJ
EXTN CESSPOOL DRYWELL MANHOLE @ S500 a
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING h
SEWER OR DISPOSAL SYSTEM @ E3 00Z
STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
44ASTE APPROVAL
CHARGES
-71 OWNERS PERMIT S z o0
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE H�7p-EIN N MED CON" REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE D SCRIBED EXIST NG DWELLING
TO THE PUBLICSEW R APPROVALS DATE INSPE R'S SIGNATURE
SIGNED THIS QDAY 19_
OWNER OR ✓ �� NEW HOUSE SEWER f
OWNERS AGENT '� ONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANKSEEP,PIT(5)
I HEREBY KNOWLEDGE THAT 1 HAVE READ T IS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORREC AND GREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT i AM PROPERLY R �jjj'Sjjj fERED
AND/OR ALTER,REPAIR SEWER OR
LICENSED AS REOUIR ' LOS ANGLES CO TYJAND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA I M THE LEGAL OWN OF//AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, TH VE DESCRIBED RESI E IA PROPERTY ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑ /
OF PERMTTT
SEEP PIT(5) ❑ CESSPOOLS ❑
VALIDATION JACK ALLt N NAA-A--
GK M O CASH SUPERVISING MECHANICAL ENGINEER v
�IL'0 4 5 3 3 ti AR16 1 0 D 7.0 0 Q