HomeMy Public PortalAbout9825 WENDON ST_Sewer__ City Of Templo City
C6EAE30G84
0 APPLICATION FOR PERMIT
2
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE County Engineer ADDRESS 9825 WeAdon Avea,
WILLIAM A. JENSEk. Supt of Building Temple Ity
F.Z.-LI
NEAREST
E A ...
FOR APPLICANT TO FILL IN CR-ss F,. Golden W033
Turnor
Of SCRAPTION LOIN OWN-
MAIL
TRACT ADDRESS endon Ave
_,j_82_5_
NoOr BLDGr
SIZE: (IF 1-,')T NOW ON LOT CITY - 6irn I Ow- I f"TTEL- -2807-7891
USE OF
DISTRICT NO. GROUP1 MAP ED BY
BUILDINGS BK PG PROCESS -
107
CONTRAC OR (-e-
T J' &D --Plumbimr,-Co- - I -It 4 "
ADORES S114 �.• o -Sam-- GAibr1i-,1.B1vd..--- -CONNECTION DATA
S'IATION DEPTH
-Gabrlel .TEL. NO._2W-_C)
_5_72
STATE: MANHOLE REFERENCE qy UPPER
HEGiSTRATION -NO. COUNTY
NO,_I_ DESCMPTION OF WORK TYPE OF CONN6,r-,T[004 L R`f
NCF
HOUSF SEWER CWNNIECTING TO Y. ,TO PSI,__
CURB
PUBLIC SEWER @ ql_��CRB-I--,--
P.L.f
SISI_ ---- - --- I � —, -- - --. , , - . 08
SERI-10 TANK,SEEPAGE PIT OR CO. IMP.NO. / e. C.NO.
PJOB
PITS AND/OR DRAINFIELD @ $10.00
HOjSE
SIEINC,EWERCONNECTiNTO
TRUNK PERMIT NO. ROAD PERMIT NO.
PpliVATE I'!'5POSAL SYSTEM @ $3.00 0
D N NCT ADDITIONAL LG.
BOOR FFIDAV NT RECORD. INSTR.NO. DA t F�
I
WORK TO HOUSE SEWER 13_00
OVERFLOW SEEPAGE PIT,DRAINFIELD
E XT N.,CESSPOOL,DRY WELL.MA NH OLE @ 58.00 1
AL ..ERUR ABTA HOUSE HW Y.OR ST.WIDENINGEYE:N 6RO-4 F-HWE WT z
SEINEROPWSPOSALSYSTEM $3,00 STAT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWM. MIT 00 _CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 11 / 91 00
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CO�VIECT THE ABOVE DESCRIBED EXISTING DWELLING j
PL
'BL THE PBL I C 'W
SFFR. APPROVALS DATE INSPECTOR S.BlqU
NATRE
SIGNED THf S--DAY OF J—
OWNER OR NEWHOU SEWER
OWNERS AGENT—----- __-__—- ---- ---— ----t`�—--
CONNECT ADDITIONAL
ADDRESS ,
BUILD NG OR WORK
SEPTIC TANK.S"I`T ` PIT(s)
( NCWrDC" 7 E.�4AT I HAVE REAL? Tfif<; APPLICATION AND/ORDRAINFIELD
AND SYA E THAT THr ABOVE IS CORRECT AND AGREE T 0 COMPLY
WITH. ALL' CO.LjNTY ORDINANCES AND 5TATE LAWS REGULATING
PLUMBING AND SEW E':RS.' CESSPOOL El ORYWELL
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
cA L I I
RE,S�FORNA OR THAT I AM THE LEGAL OWNER OF, AND
PTEND TO D;SCONNF'C;T PLUG AN
DE IN THE ABOVE DESUR I.JED RE51DENTIAL PRO..7,Iff i Y ABANDON HOUSE SEWER
SIGNATURE
OF PERMITTEE j BACK FILL SEPTIC TANKS
SEEP,P11 IS) ❑ CFSSP0c)c5,
vALIPATION ROBERT A. WOOD
CK. a A
SUPERVISING MECHANICAL ENGINEER
-I