HomeMy Public PortalAbout6310 SALTER AVE_Sewer__ '6A 6420-CEBUB - tO-71
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FNEAREST
/31N. Salter Ave•b�i1i�U /^t }.Temple City
FOR APPLICANT TO FILL IN �Ong eyi Ave, _ --
LEGAL.
DESCRIPTION LOT NO. ti'.,�.. r.,. OWNER Richard. Bowen
_ I
BLOCK TRACT MA
� L,e� Y-- ADDRESSL 1.620 Melanie Ln.
NO. OF SLOGS,
SIZE OF LOT 76,X/o j� NOW ON LOT CITY Arcadia TEL, NO.
USE OF
BUILDINGS j-e$ DISTRICT N0. GROUP MAP ROCS 55EU BY
_ BK PG �r
CONTRACTOR Square -De
al eWe�'_�ery i c
ADDRESS 2993 axson M CONNECTION DATA
Ad.. j�
CITY El Monte TEL. NO. 44�`I'.-2020 STATION � �J DEPTH �1
STATE LIC MANHOLE REFERENCE / y �R'�—
LICENSE NO, 1,280 CLASS .. + +J�^�R/4l y,_ -LOWER
NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION J LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $.7.00
SEPTIC TANK.SEEPAGE PIT OR }' -> ` P.C.NO.
PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO, ( JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. >-
PRIVATE DISPOSAL SYSTEM Q $3.00 CL
CL
CONNECT ADDITIONAL .NO.BLDG.OR AFFIDAVIT wAIYER ERSEME Ni RECORD.INSTRDATE U
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD C,
EXTN..CE5SPOOL.DRYWELL. $500
ALTER.REPAIR OR ABANDON HOUSE o
HWY.OR 5T.WIDENING
SEWER OR DISPOSAL SYSTEM @ $3.00 ----- U
-- STATE ENCROACHMENT -.7 Lu
MANHOLE 0 $7.00 PERMIT NO. v� a
INDUSTRIAL En
WASTE APPROVAL Z
OWNERS PERMIT E 31 00 CHARGES
AUTHORIZATION I TOTAL FEE 6 looCONNECTION CHARGE FEE
1 HAVE 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
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15
CORRECT AND AGREE TO COMPLY
WITH ALL 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
CALI FOR NIA OR THAT i AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RESIDEP*3(Al- PROPERTY. ABANDON HOUSE SEWER
SIGNATURE } 2.f�-✓ _
OF PERMrrTE.2 e-- .P' BACKFILL SEPTIC TANKS ❑
SEEP,PIT(S) "CESSPOOLS ❑
VALIDATION cK. M.O. CASH
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