HomeMy Public PortalAbout9707 VAL ST_Sewer__ 76A 642D-CE806-10-71 APPLICCAp1ON F PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDIHG
ADORE!! 9707 E. Val St.
LOCALITY Temple Cit
LEGAL FOR APPLICANT TO FILL IN CR.. ST Golden West
DESCRIPTION LOT NO OWNER Richard Bowen
BLOCK TR G L ADDRESS ] 620 Melanie Ln.
.may NO OR a o6
SIZE OR LOT , M NOW ON LOT CITY Arcadia TEL NO
USE OR
[U ILDINO! $e8• DISTRICT NOROU
GP MAP El6ED BY
eK rO
CONTRACTOR Square Deal Sewer Service �'pS �— L�w,
AGDREBS 2933 Maxson Rd. CONNECTION DATA
CITY E oI to TEL NO 44- STATION /�+ DEPTH
STATE
NO 12OLJ 0 A. -42 MANHOL[l`P-[//F[RIENCC � � `� LIPPER�
NO DESCRIPTION OF WORK F[[ YPE OR CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TOY CURB P L ML TOP L
1 PUBLIC SEWER C $700
SEPTIC TANK SEEPAGE PIT ONP C NO
PITS AND/OR DRAINFIELD 0 910 00 CO IMP NO 3 72 JOB NO
HOU89SLW[R CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO a
PRIVATE DISPOSAL Sy
OTCM O S!OO O
CONNECT ADDITIONAL ILD* OR AFFIDAVIT {.fPT[ TAO...T RECORD INS" NO DATE u
WORK TO HOUS
E S[WCR O ..00
OVERFLOW SEEPAGE PIT GRAINFIELD
CETN CESSPOOL ORYW[LL Y 8900 HWY OR ST WIDENING W
ALTER REPAIR ON ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM O $100 STATE ENCROACHMENTIT A{ OSHA
1 �]YJ P7f�
MANHOLE 0 $7 00 PERMIT NO C T L SHA 1 L I 14 a
INDUSTRIAL W
�S}}��pp WAST[APPROVAL Z
O����TE.l1Rms PEHM s J 00 CHARD"
CONNECTION CHARGE FEE
AUTHORCLATION TOTAL FEE 10 00
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F[[
TRACTOR TO CONNECT THE ABOVE DESCRIBED MISTING DWELLING
TO THE PUBLIC SEWER AMOVAIS DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_ Y
OWNER OR NEW HOLIES SEWER
OW NCRS AOCNT CONNECT ADDITIONAL
AGGRESS BUILDING OR WORK
SEPTIC TANK BEEP PITIO)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION [DI1M0..ECT
/OR ORAINFICLD
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
PLUMBING AND BOWERS POOL ❑ DRYW[LL ❑
1 HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORR REPAIR SEWER OR
LICENSED AS RCOUIRCD BY LOS ANGLES COUNTY AND STATE OFAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNCI OF AND INTEND TO PLUO AND
SIGNATURE
IN TMC ABOVE O(BCRIS[O R[SID[N AL P OP[RTY
O{/f/ DON HOUSE SEWER
SIGNATURE
OF PGYfTTL[ � FILL S[PT�'T1�NN PITCbS OOLS
VALIDATION CK M G CASH
1 9 4 AUG 1 O.O 0