HomeMy Public PortalAbout6622 OAK AVE_Sewer__ APPLICATION..POR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer
County of Loa Angers 3I ItDtNG .w
JOi-{i,i A. LAMBIE, COUNTY ENGINEERADDRE°S
CASSATTD. CGRIFFIN, SUFI'ov SU1{..DIN.B - LOCALITY
�j
NEAREST
FOR APPLICANT TO FILL IN � cROSS ST IEGALrg 7�^[� _
CESCPIPTION �OT NOjr 1�' - `'_...�,� _�aWNER_. J' —
___ .
y
BLOCK TRACT .� MAIL
r N0. OF BLDGS. y ,ITY �r r... TEL, NO,
SIZE OF L01' _ _ NOW ON LOTf _ _ b�.�.-..- _
}sE DISTRICT NO, GROUP MAP
CONTRA CTOR,.r, ' RK o `
ADDRESS CONNECTION DATA
�� $TAT I O F! Z `"'� d..-� DEPTHg;
Y � �' TEL
CITNO. ' �. --- - -- -- --- --
---�. MANHOLE REFERENCE ,+� �` f�:_ „'r �.� x�PER.r�...
STATE
REGISTRATION NO, ❑ COUNTY 'NO. j DESCRIPTION OF 4�I0'?h FEE
_- TYPE OF CO TION LENGTH FROM
I MOUSE SrVI CONhLC11NG T,i - >
i PUBLIC SFWFR li a .Sljt t..l _ _ -- PFT. P:L - r
L.To P G.-_.ra�°'s..-
—� SEPTiGTANK,SEEPAGE PIT OR ------ `.- -_1 _--- s
_J PITS AND OR DRA,INF ELD $3.00
OVERFLOW SEEPAGE PIT,DRA to FIELD - e 'P L NO.
EXTSI.,CESSPOOL,DRYWE`L, MANHOLE $ 2.00 { CO. 1Ft P. NO. �.� _ e,:,-...,,.may_., JUB NO
f HOUSE.SEWER CONNECIING TO _ ,
PRIVATE DISPOSAL SYSTEM
g I.00 I RUNY. PERMIT NO. ROAD PERMIT NO
CONNECT ADDITIONAL BLDG,OR i i STATE ENCROACHMENT -
yl0is'K TO riOL•SE SE4YER <i $i.G'l .PERMIT N0,
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Ia $1.00IAS°TE APPROVAL
I
i
CHAPGES
CONNECTION CHARGE FEE -
OWNER'S � PERMIT � -=}1 00 REIMBURSEMENT F£E�--- ------ ---
AUTHORIZATION TOTAL F££ P� y[
I HAVE AT THIS DATE, A CONTRACT WH HEREIN NAMED CON- APPROVALS —_- DA.It INsrECTOR'SSIGN.ATURE
TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXIST'INC DWELLING
- -- '--- -r -- ------ ---
TO THE PUBLIC SEWER. - NEW HOUSE SEWER i.
SIGNED THIS DAYOF r ' J 19 CONNEc ADDITIONAL
AD
OWNER OR tl I L � UUILDiNG OR WORK-- ---
C'h'NER5 AGENT '�71. SEPTIC TANK,SEEP.PIT ISI---�----------�
c AND/011 DRAINFI" LD
k.FF FPY-ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL D URYW/ELL O { -.
AND STATE THAI THE ABOVE 15 CORRECT AND AGREE TO COMPLY
NTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR.SEWER OR '_+-----
PLUMPING AND SEWERS. - SEWAGE DISPOSAL SYSTEM i
1 Hr RE", CER i..Y THAT 1 AM PRCFE LY ST RED AND/OR
S
�,�
TY AND STATE O DISCONNECT PLUG AND
LICENSED AS R Q1-tRED BY LOS A4t�ELE r
ABANDON HOUSE SEWER i
ALFORNIA OR ieiA'i "AM T}iE LEGAL OF THE ABE --- - - - -- - —i --- --
DESCRIBED RLS ENTiA111ROPERTY, _ -�9" LACKFILL SEPTIC TANKS El
SIGNATURE _SEEP. ;S_1 (_j C1i.StiP00 LS I7 -1
OF PERMIT
--- _,
l
1OHN A. LAMBIE, COLT r ENGINEER IDATIO p o»E i-r A.WOOD, CHIEF PLE3G. INSPECTOR
GK. Id. G -CASH
✓4i,,:rt ��.�t-m'�' .r. UJ'T
� E
4
P
COUNTY OF LOS ANGELES
-E808 2/70
"6.A 64Zr,* APPLICATION P-6 REMIT
DEPARTMENT OF COUNTY ENGINEER DEPARTMENT' E DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 6622 N.
COLEMAN W. JENKINS, SUPT. OF BUILDING AD
L CALIYY Te I-tL
APPLICANT TO FILL IN FNEARES1
CROSS ST Camino At
fPRINT OR TYPE ONLY)
DESCRIPTION LOT NO. OWNER
MAIL
_BLOCK_ TRACT ADDRESS 6622 N. Oak Ave.
NOW0OFNLT BLD
GS.
CITY Temple Cit:PEL. NO.
SIZE OF LOT NO
USE OF
BUILDINGS IDtgTRiCT y 0.[R�OUPICLAss I VIAP E S SFD BY
-I-----_- -z -; PG'
CONTRACTOR
ADDR-ESS- Gab r it,l-B1vd*-j---- CONNECTION DATA
CITY STATION DEPTH
_GAbr_i
TEL NO.
STATELIC UP R
LICENSE NO; 2-W896 CLASS MANHOLE.REFERENCE -LOWER
NO. DESCR PTION -------
OF WORK FEE TYPEOF CONNECTfON LENGTH FReW
HOUSE SEWER CONNECTING TO Y CUREI-, PL Y..
PUBLIC SEWER 0 $500 .-- " ----m -
=SE P�f I-C-�A�NK S�EE E-P A—G E 4�il- OR i P.Cwo
PITS AND/OR DRAINFiri,o @ $10�00 CO.IMP, NO- J?5'i N 0.
7-)4 OU SE SEWER TRUNK PERMIT NO.
I CON -6�'P
1 PRIVATE r,:SPOSAL SYSTEM @ 3.?0 ROAD -F�MiT NO.
RECORD.INSTR.N
AFFIDAVIT AIVCi DATE
i CONNECT ADDIT16NAj-BUD 0
�V�ORK�TO HOUSIFSEWER %3.00
OVERFLOW
EXTN..CES SPOOL.DRYWF.LL.M 4HOLE0 $5.00
ABANDON HOUSE-
HWY, OR,66WIDENING
-AL SYSTEM
STATV'ENCROACHMENT
PEROIT No. uj
Ct.
AL
WASTE APPROVAL
CHARGES
O7------
S
PEIRm
IT $ 00
AUT ,VvmHORIZA,1TION TOTAL FEEi CONNECTION CHARGE FEE-- -------
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON, REIM.BURSEMENT FEE
TRACTOR
RACT 0 R 'T 0 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
HE PUB IC SEWER
TO T L APPROVALS DATE INSPECTOR'SS;GNArURE
SIGNED THIS DAY OF_
OWNER OR NEW HOUSE SEWER
OWNERS
CONNECT ADDITIONAL
ADDRESS _9U I LO;NG OR WORK
I HFREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION iF T�.C�ANK,SEEP, PITIS)
AND/OR DRAINPiELO
AND GTATE THAT THE ABOVE: Is .oRRE:cr AND AGREE TO COMPLY
STATE LAWS REGULATING
WITH ALL COUNTY ORDiNANCES AND
FLUM a E CESSPOOL 0 PRYWELL
ING AND SEWERS.
HEREBY f:ER'ri!`Y THAT I AM PROPERLY REGISTERED AND/OR AL7ER,REPAIR,SEWER OR
LICENSED4AS REQUIRED
BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
p' S IN, THE ABOVE. DESC�W ED RESJDENTIAL ip'Ropzwry.-- FORNfA OR THAT I AM,THE LEGAL OWNER OF, AND INTEND TO DSiCONN F'C PLUG AND
ABANDON HOUSE SEWER
,NATURE
F PERMTTTEE-� BA-'-KFILL SEPTIC.TANKS i.
SEEP,PITiS) CESSPOOL Lj
VALIDATION JACK R. ALLEN
CK. @r1.O. CASH SUPERVISING MECHANICAL ENGINEER