HomeMy Public PortalAbout9703 VAL ST_Sewer__ 76A 542D-CESOf-10-71 APPLICA ON FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
A OGRESS O E . Val St.
LOCALITY Temple Cit
FOR APPLICANT TO FILL IN =AOS BGT Golden West
DESCRIPALTION LOTNO OWNER Richard Bowen
BLOCK �� ADDRESS 1620 Melanie Ln.
No OF eLDOi
Blz[ OF LOT Now oN LOT cm TEL NO
us[ of
BUILDINGS Res, DISTRICT NO GROUP X MAP PO CC56lD BY
E
GONTRACTOR Square Deal Sewer ServiceU8 ..� �'d
ADDRESS 2933 maxson
/1111144 STATION CONNECTION DATA
4
CITY El Monte TEL NO —2020 DEPTH
L IC[NSE NO 1288 0 CLAee STATE —LF2 MANHOLE REFERENCE Cy
NO DESCRIPTION OF WORK FE[ TYPE OF CONNECTION o LENGTH FROM /
1 HOUSE SEWER CONNECTING TO Y CURE ML TOP L
PUBLIC SEWER fT 00 00 PC MO
eQPTIC TANK ([[PAG[PIT OR CO IMP NO Z JOB NO
PITS ANO/OR pwAINFICLD 8 31000
NOUS(SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM TgUMK PERMIT NO ROAD PERMIT NO
y
0 3]00
CONNECT ADD ITIONA LBLDO OR AFFIDAVIT u.[• W[R[Rf R[CORO INS" NO DATE O
v
WORK TO NOUS[SEWER Y $300
OVERFLOW SEEPAGE PIT GRAINFIELD OC
EKTN CESSPOOL ORYWELL f500 O
ALTERREPAIR OR ABANDON HOUSE HWY ORBT WIDENING
SEWER OR DISPOSAL SYSTEM SSM
STATE ENCROACHMENT �y1
MANHOLE O fT 00 PERMIT NO d
INDUSTRIAL
WAST[APPROVAL Z
n CHARGES
OWNEH�S PENFfff f ] o0
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FE!
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
DWELL��INN
TO THE PUBLIC SEWER A WOVAW DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OP I9_ T
OWNER OR NEW HOUSE SEWER
OWN IRSAO[NT
CONNECT A IAL
ADDRESS
BUILDING ORR WOR WORK
Q[PTIC TANK BEEP PIT(S)
1 ON H!R[BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIAND/OR GRAINFIELD
AND STATE THAT THE ABOVE IB CORRECT ANO AORC[ TO COMPLY
WITH ALL COUNTY OROINANCES AND STATE LAWS REGULATING
PLUMBING AND $EWERS CESSPOOL ❑ DRYW[LL ❑
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMO/OR ALTER REPAIR SEWER OR
LICENSED AS R[OUIRED BY LOS ANGLES COUNTY AND STAT! OF S[WAOE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER F AND INTEND TO DISCONNECT PLUG AND
REBID( IN THE ABOVE D[8CR1 D R[QID[NT P P[RTY
a`II ABANDON HOUSE G CR
SIGNATURE
OF PERMTTTE[ B CKFILL SEPTIC TANKS
S (P PITISI POD"
V a*maTION CN M 0 CASH
1 9 5PAUG 25 10 D