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Home My Public Portal About5426 WELLAND AVE_Sewer__ TEMPLE CITY ' soa 8 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING CSS ASSATT D�AGRIFFIN Supt of Build ng - LOCALITY . NEAREST FOR AI'.PLICANT TO FILL IN CROSS ST. , LEGAL DESCRIPTION LOT NO. OWNER - BLOCK TRACT MAIL _ ADDRESS NO:OF B�6GS! .�. SIZE OF LOT NOW 014 LOT CITY I`EL. NO. USE OF 6UILDINGS DISTRICJNO, GROUP MAP PROCESSED BY BIC PG CONTRACTOR P / -- lADDRESS �' - CONNECTION DATA CITY �/ TEL NO SX16 ON , a DEPTH r , . 'STATE MANHOLE REFERENCE - UPPER REGISTRATION NO, COUNTY Lflyyg —r NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER $3.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. CURB P L, M.L.TO P.L. PITS AND/OR DR.AINFIELD @ $3.00 - OVERFLOW SEEPAGE PIT,DRAINFIELD "�� C � .._ ,. .> _ EXTN:.CESSPOOL. DRYWELL @ $2.00 _ HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $.1.00 CO.IMP. N "i3' J JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. '.ROAD PERMIT 140. 1 WORK TO HOUSE SEWER $1.00 SYSTEMER REPAIR OR ABANDON 14OUSE S€1VER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT PERMIT N0, INDUSTRIAL y^' � WASE APPROVAL J t CHARGES',X OWNER'S PERMIT � �---�:(( CON_NECa 10N-.CHARGE PEE AUTHORIZATION TOTAL FEE I REIMBURSEMENT FEE I HAVE AT THIS DATE A CON-IRAC7WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE �INSPECTOWSSIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 1°3 " NEW HOUSE SEWER OWNER OR. _ CONI;EG7 ADDi7d.ONAi. OWNERS AGENT - BUILDING OR WORK f ADDRESS SEPTIC TANK,SEEP.PIT(S) }� AND/OR DRAIN.FI,ELD I HEREBY ACKNOWLEOGE THAT i PAYE R€AD. Tota APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CE'S:SPOOL ❑ DRY-WELL [I I WITH ALL COUNTY ORDINANCES ANIS STATE LAWS REGULATING SEWER OR REPAIR TER t. , , PLUMBING AND SEWERS. A �y I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED SEWAGE DISPOSAL SYSTEM AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTYANDSTATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL. OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS [� SIGNATURE s✓ i a s SEEP. PIT(S) CESSPOOLS OF PERMITTE F S d ANON ROE3E T A. WOOD c"H .SUPERVISING MECHANICAL, ENGINEER CITY :98 t3 8.53 808 8 APPLICATION FOR PERMIT :E 77 COUNTY OF LOS ANGELES SEINER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Sup't of Building LOCALITY NEAREST- . FOR APPLICANT TO FILL IN CROSS ST, LEGAL —6i- - - DESCRIPTION LOT 140. OWNER BLOCK TRACTMAIL " e _ADDRESS 4 NO OF BbDGS, SIZE OF LOT NOW ON LOT USE OF CITY i-!� TEL. NO. BUILDINGS DISTRICTNO. GR?UP'j MAP PROCESSED BY BIS PG CONTRACTOR ° J ADDRESS ! _ CONNECTION DATA u CITY TEL., . — STATION - DEPTH s NOd _ s r (= STATE MANHOLE REFERENCE. j"- .. UPPER REGISTRATION NO. - COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER (� 53_00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y.� CURB P,L. M,L.TO P.L. PITS AND/OR DRAINFIELD Lo) $3.00 _ •,,�OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN,.CESSPOOL. DRYWELL $2.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM 0 $1.00 I CO,IMP.NO, i JOB NO. > CONNECT ADDITIONAL SLOQ.OR TRUNK PERMIT NO. ROAD PERMIT NO•/-! V1flRK T'0 HOUSE SEWER C� 51.00 ALTER REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWEROR DISPOSAL.SYSTEr.i '9:00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT 2 [�00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE T J� I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS i DATE INSPECTOR'S SIGNATURE. TO THE PUBLIC SEWER, SIGNED THIS I)AY 0 i9— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT CONNECT OR WORK ADDRESS. SEPTIC TANK,SEEP,PIT(3) ®— AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STA'iE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ® DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL.SYSTEM I _ I HEREBY CERTIFY THAT S AM PROPERLY REGISTERED AND/OR OF DISCONNECT PLUG AND CALIFORNIALICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNOR THAT--; AM THE LEy�1L OtVI+(ER OF THE ABOVE DESCRIBED RESIDENTIAL, PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE r i y SEEP.PITS ❑ CESSPOOLS ❑ OF PE:R'iIAITTE VALIDATION ROBERT A. WOOD CIC. Yd.A. CASH 5UPERVISING blECHANICAL ZNGIPIEER iu.�,"9 1 4 4Q Air 1 1 0 0 7.00- 0- �: