HomeMy Public PortalAbout10903 WILDFLOWER RD_Sewer__ i6AE-66 APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING 1.0903 Wildflower Rd*
JOHNA. LAMBIE, COUNTY ENGINEER ADDRESS -em-o
le CASSATT t3. GRIFFIN, SUPT OF.BUILDiNG - LOCALITY City-I Calif. -
NEAREST Welland Avenue
_ FOR APPLICANT TO FILL IN CROSS ST.
LEGAL .I. OWNER i m C ld.OruC l fl
_DESCRIPTION LOT NO,_ ff�� s']
BLOCK —TRACT 23949 ar _ADDRESS !2 San- Gabriel _ °BlvdD
N0. ON LOT OF BLDG5. CITY Gabriel P TEL. N0.A
SIZE OF LOT _NOW �-05 1
_ _
USE OF DISTRICT No. GROUP MAP
BUILDINGS
residenceBK PG
CONTRACTOR 'S�• -o--
—� rb m ruction
CONNECTION DATA
ADDRESS gfiSt . � 1Tpac;.-. .:✓ ,r --
p STATION -J + ,,;"�✓ DEPTH
CITY `i .a TEL. NO. -
y��``u�-� MANHOLE REFEREPICE
_ LOWER
REGISTRATION N0. 113613 G 42 _
NO. DESCRIPTION OF WORK FEE TYPE OF CON-NECTIO ,'^LENGTH FROM
------ ---- r..� ..:
HOUSE SEWER CONNECTING TO - -�-' y_ CURB '`�P t. � M. TO P.L. - I
PUBLI_CSEWER__ _ @ $3.50 ----- -- ---��,,,»-�'----- -aK----
j 'SEPTIC TANK SEEPAGE PIT OR
EP
PITS AND/OR DRAINF ELDt.' _$5.00_ -- - -
OVERFLOW SEAGE PST,DRAtNFIE:LD _T - P. C. NO.
EXTN.,CESSPOOL,DRYW,.LL,N,ANHOLE $2.00 CO. IMP. NO. _ _-_ JOB NO-
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM. —C S I.00 _TRUNK PERMIT NO.. _ ROAD PERMIT 140.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER C' $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE ( INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1.00-_-.�---- WASTE APPROVAL -
-� ----- --- ---------- -- CHARGES
1 --- ----.-_�--- ------ CONNECTION CHARGE FEE
OWNER'S PERMIT $ i 1 00 --- - - — --------—-
------------ ---
----- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 4 0
1 HAVE AT THIS DATE A CONTRACT WIT14 THE HEREIN NAMED CON- ---------_APPROVALS
DATE - INSPECTOWSSIGNATURE
TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXISTING DWELLING j
TO '1-11,E PUBLIC SEWER. NEW HOUSE SEWER
SIGNED TMS--DAY OF_ CONNECT ADDITIONAL i
OWNER OR BUILDING OR WORK
OWNERS AGENT_— r::�L� _ -__. ._--- -----------'---- ----------- -
�K-" ------ --------- SEPTIC TANK,SPEP, PIT(5) I
ADDRkSS AND/OR DRASNFiELD`
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATIONi l
AND STA'f.rr CESSPOOL[] DRYWFLL u
3"� TtE ABOVE IS CURRECI AND AGREE TO COMPLY"
WITH AL COt;NiY ORDINANCES AND. STATE LAWS REGULATING ALTER,REPAIR,SEWER OR �
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM J ---__-
I HERE-3Y CERTIFY 7tidT I „A4 PROPERLY REGISTERED aNDGR . i
LICENSED AS REQUIRED EY LOS ANGELES ,,� NTY O,ND STATE ;F DISCONNECTP UG AND I
CALIFORNIA OR 1 HA,T I AM Tr1E LrF.GA,1c''OW R OF THE ABO,'E ABANDON HOUSF SEWER_ --
--
DESCRIBED RESIDE L -'TY,, �° ,'"- EACKFILL SEPTIC TAIV ICS r] t
-`y� '.. r*y_ SEEP f iTt i ;� CESSPOOLS[, I
SIGNATURE �t-s. +C�;;. ..- .---- PO --i- ---_..- --_.___—.---
OF PERI411T r~ �. { i - --`-
i
JOHN A. LAMBIE, COUNTY ENGINE ,VALIDATION ROBERT A.V'tiIOOD, CHIEF PLEIG. INSPECTOR
CK+� t1..O. CASH