HomeMy Public PortalAbout9213 LONGDEN AVE_Sewer__ �Esw�o 67
'6AI,420 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 9213 Longden Avenue
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple Clity, Calif.
FOR APPLICANT TO FILL IN NEAREST
ICROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER City of Temple City
MAIL
BLOCK TRACT ADDRESS N. Kauffman Avenue
38
NO. OF BLOGS.
SIZE OF LOT NOW ON LOT CITYT.0 , CalifVEL. NO.
USE OF
BUILDINGS DISTRICT NO.1 GROUPI 13K MAP P G PROCESSED BY
CONT RA.TJ:
O,R Is Wr o
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ADDRESS 135 N. Daisy Avenue CONNECTION DATA
.,TyPasadena, Cal-�,f .. 796-4051 STATION DEPTH
TATE LIC SS MANHOLE REFERENCE PER
5 13370 LOWER
LICENSE NO., CLA C-21
NO DESCRIPTION OF WORK FEE LENGTH FROM
C-
-40USESEWIER OWNECTiNG TO Y. CURB P.L. ML.TO P.L.
PUBLIC SEWER @ $5.00
I �1�NO.,
N 0
SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. 1 � 0
PITS AND/OR DRAINFIELD @ $10.00 _
[HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $3�00 TRUNK PERMIT NO. PERMIT NO.
RECORD.IN -F-MATE
BLOG,OR VER EASENEt!- sTR.NO
1
CONNECT ADDITIONAL 0
_WORK TO HOUSE SEWER @ $3.00
EE
PAGE PIT DRAMFIELD Lu
OVERFLOW�
I EXTN..CESSPOOL ORYWELL,MANHOLE @ $5.00 t
SE
Hwy�OR ST.),VIDENING
A;je&*&49�BA NOON HOUSE 11
-4 'DISPOSAL SYSTEM__-- @ $3.00 STAIiE ENZ-OACHMENT z
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT 21 00
CONNECTION CHARGE FEE
AUTHORIZATION 1--TOTAL 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 j.NSPE.T-R'..I.NATURE
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 THAI' I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORD INANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL El DRYWELL El
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR
LICENSED AS REQUIRED By L OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CAL�FORN I A OR THAT I AM THF
F LEGAL OWNER OF. AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBEPI RESIDENTIAL PROPERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATURE Z�
BACKFILL SEPTIC TANKS
0
F PERMrTlE
SEEP,PIT(S) 17CESSPOOLS. 49�1
VALIDATION, JACK R. ALL
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
I
A