HomeMy Public PortalAbout5621 NOEL DR_Sewer__ 76A°°Y° APPLICATION FOR PERMIT 1
8.Y s. I
D MSION OF BUHM MG AND SAFETY SEWER—SEWAGE DISPOSAL
Depwtment of County Engineer
County of Los Angeles noDREssG O N
JOHN A LAMBIE COUNTY ENGINEER �r
® oel
CASSATT D GRIFFIN,SUP T of BUILDING LOCALITY Temple Cit
FOR APPLICANT TO FILL nq NCRoss sr stied ewood
LEGAL
DESCRIPTION LOT NO Q OWNER Mr. 1Tilll am Cath
MAIL 621 No. Noel
BLOCK TRACT ADDRESS
NO OF
SIZE OF LOT NOW ON LOTS CITY eranle CitV TEL NO At. 7L309
USE OF DISTRICT ( GROUPI MAP BUILDINGS
K PG
CONTRACTOR J & D Plumbing Co.
ADDRESS 715 ]+',,- Broadway
CONNECTION DATA
CITY San Gabr ie lTEL NO AT. 77832 STATION DEPTH
MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 30
HOUSE SEWER CONNECTING TO Y CURB P L N L TOP L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE @ $200 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM a $100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL 1 WORK TO HOUSE SEWER`DG OR ® $1 00 1 OO PERMISTATE T NoEN
ALTER
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® $100 WASTE APPROVAL
1
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 00
AUTHORIZATION TOTAL FEE 73 00 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGEN� SEPTIC TANK SEEP,PIT(S)
ADDRES AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ HIS.APPLICATION CESSPOOL❑ DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE AS VE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PITS) ❑ CESSPOOLS❑
OF PERMITTEE J T. Pa zli
JOHN A LAME4IE COUNTY ENGINEER ATIO ROBERT A WOOD CHIEF PLBG INSPECTOR
CK Y 0 CASH
7 Ot DEC 1 10 A 3.0 O ;R
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