HomeMy Public PortalAbout10144 NADINE ST_Sewer__ 10 TEMPLE CITY
C08270 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B
UILDING
ADDRESS 10144 E• Nadine St.
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING Temple it
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APPLICANT TO FILL IN ST
(PRINT OR TYPE ONLY) ST ]�
LEGAL
DESCRIPTION LOT NO OWNER Miltoin Bade
MAIL
BLOCK TRACT ADDRESS
NO OF SLOGS
SIZE OF LOT NOW ON LOT CITYArCjadig TEL NO
USE OF DISTRICT NO GROUP CLASS MAP CESSED;BY
BUILDINGS BK Pp
CONTRACTORSqUare Deal Sewer Service
ADDRESS 2933 MaxSOII Ed. CONNECTION DATA
CITY El Monte
TEL NO STATION J'L DEPTH is
STATE
LICENSE NO 128870 GLASS - PPER
MANHOLE REFERENCE
� LOWER
NO DESCRIPTION OF WORK FEE YPE OF CONNECTION LENGTH FROM �7
1 HOUSE SEWER CONNECTING TO CURB P L ML TO P L (,
PUBLIC SEWER 40 $5 00
SEPTIC TANK SEEPAGE PIT OR PC NO 'jj. qd1
PITS AND�OR DRAINFIELD 51000 CO IMP NO JOB NO ((
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO /��J� y
PRIVATE DISPOSAL SYSTEM S300 TTTT A�.vv O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIY91 [11f1N[MT RECORD INSTR NO DATE
WORK TO HOUSE SEWER $300 V
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE a 55 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING 0
SEWER OR DISPOSAL SYSTEM ® $300 STATE ENCROACHMENT W
PERMIT NO
CIL
INDUSTRIAL N
��+� WASTE APPROVAL Z
OWNER S PEIImT s 2 00 CHARGES
AUTHORIZATION I TOTAL FEE 1 10100
CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTORPTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE UBLIC SEWER
AROVALS DATE PECTOR S SIGNATURE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER !!
OWNERS AGENT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK BEEP PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
1 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 1 AM THE LEGAL OWNER OF NO INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL OPE ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE BEEP PITS) ❑ CESSPOOLS ❑
CC
VALIDATION JACK R ALLEN
M o CASH SUPERVISING MECHANICAL ENGINEER
V-1-V
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