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Home My Public Portal About6029 PRIMROSE AVE_Sewer__ TEMPLE CITY '6A 642D+CE408 10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESIS NG 6029 Ni . Primrose Ave. TY Temple Cit T FOR APPLICANT TO FILL IN ST. Garibaldi LEGAL - DESCRIPTION LOT NO. OWNER Odie Vaught MAIL I BLOCK TRACT' ADDRESS 61. VQ N. Loma NO. OF BLDGS. SIZE OF LOT NOW ON LOT CIT e e CitV TEL. NO. USE OF p BUILDINGS Res. DISTRICT NO. GROUP BK p5 MAP PH OCESSED BY Square _ CONTRACTOR Deal Sewer Service '; - "7 � �J` ,� _ ADDRESS2933 Maxsoyi CONNECTION DATA CITY El Monte TEL. o44 "4-2020 STATION -/ DEPTH �.' STATE '1 rj4O O LIC ry��i] - �,..T LO E@....... LICENSE NO. 1 !. 887 CLASS c 4 MANHOLE REFERENCE NO. DESCRIPTION OF WORK FEE y R -,LOWER" OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L.y= M.L.TO P.L. PUBLIC SEWER 0 $7.00 -- P.C.NO. SEPTIC TANK.SEEPAGE PIT OR JOB NO. PITS AND/OR DRAINFIELD Q $10.00 CO.IMP.NO. HOUSE SEWERCONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, a. PRIVATE DISPOSAL SYSTEM 0 $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIYEII EASEMENT RECORD. INSTR.NO. DATE O ( WORK TO HOUSE SEWER $3.00 Ln�,. U OVERFLOW SEEPAGE PIT,DRAINFIELD ix EXTN.,CESSPOOL.DRYWELL. $5.00 HWY.OR ST.WIDENING O ALTER,REPAIR OR ABANDON HOUSE F SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT _ u MANHOLE PERMIT NO. _ r �%^ � A $7.00 -- INDUSTRIAL ' _� h WASTE APPROVAL f 3 Z OWNERS PERMIT $1 31 00 CHARGES 1y CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE f' f HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC $EWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT - CONNECT ADDITIONAL - BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I 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 I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AN RESIDE IN, THE ABOVE DESCRIBED RES[ 17 PROPERTY. ABANDON HOUSE SEWED SIGNATURE L / / L BACKFILL SEPTIC TANKS ❑ OF PERMTTTEg_ '+�_ L [3---"— - SEEP.PIT(S) ❑ CESSPOOLS VALIDATION CK. M.O. CASH r'�_ '6A 642'D -ZrE808-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS rp -r 1-�. � LOCALITY ..� _ NEAREST FOR APPLICANT TO FILL IN CROSS ST. ----LEGAL ___-_-- DESCRIPTION LOT NO •Z co c/ OWNER MAIL BLOCK TRACT ' ADDRESS /f, Y NO. OF BL GS, SIZE OF LOT L�" R +� NOW ON LOT CITY TEL. NO. -_ USE OF ,-- BUILDINGS .:.. DISTRICT N0. GROUP 8K PG MAP PROC SSED BY CONTRACTOR / n ADDRESS I _ CONNECT�IOON DATA CITY -34 NO. L 11 --ry- STATION - / DEPTH STATE _ + LIC MANHOLE REFERENCEUPP LICENSE NO:.,{ `-V.�( ; _� ��,. - GLA55 �3.-- ; , LOWE NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION-, LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER 0 $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ E10.00 CO. IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. a PRIVATE DISPOSAL SYSTEM Q $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -1ASEN[RT RECORD.INSTR.NO. DATE V WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD (� EXTN..CESSPOOL.ORYW @ ig.00 . ALTER,REPAIR O HWY.OR 9TWIDENING ANDON HOUSo SEWER OR DISPOSV$45TE`I�J 0 $3.00 STATE ENCROACHMENT W MANHOLE ! $7 00 PERMIT NO.( d INDUSTRIAL N WASTE APPROVAL Z OWNERS PERM $1 3 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE 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 INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORD NANC E5 AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT I 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 I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND / r g RESIDE IN, THE ABQVE DESCRIBED RESIDENTIAL PROPERTY. ARAN DOfj+rf6USE �" (� 7 - SIGNATURE OF E BACKFILL SEPYIC TANKS ❑ PERMITTE ❑ S EP.PITS) ❑ CESSPOOLS VALWATI N CK. M.O. CASH