HomeMy Public PortalAbout10907 WILDFLOWER RD_Sewer__ E608 10-63 t
6A642D `_,APPLICATION FOR PERMIT t
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION SU:LOING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. IENSEN. Supt of Building
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Y7EARC.ET _
FOR APPLICANT TO FILL IN c���5— — ' '' `s r _
LEGAL - ,;+• ,
DESCYIPTION LOT NO _.. .._._ _..._-. OWNER .-
MAIL
BLO
OT
SI',KFr OF LOT IR.ACT- '✓�..�J O, F BLDG-9, 4',V .+: p�, CDDRES� .'� •a / h0 - ---.
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BUILDINGS ,'<L" /A 9" y,�6 _._ 4 STA'. IVU st2 .4J?' MAP PRO MSEC 6Y
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CONTRACTOR
ADDRESS ,�� f.- CONT ECTION DATA y.. .
cITY '" L N0. _ TR
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STATE
MANHOLE REFERENCE ---'- _----
RE(+15TRATiON 40. ❑ COUNTY LOW_.R
NG- DESCRIPTION OF WORK
FE.E_ TYPE._OE_CO N NEC—T_iaN —__---. - _._._F_N..:7_F_FROM.
HOUSE
..
P.L.
I Y. CURB P.L. M.L. ,.•'-
HOUSE SEWER CONNECTING TO TO I
I P ISLIC SEWER @ SS Do a.
-_-V P.C.N.O. y'y
1-'4 C'z'T f.:TAN �EEPA GE PIT OR
a ,S aN01 Or?ORAINEIELD. Q CO. PMP NO, J.OB.NO.
I HOUSE SEWER CONNECTING TO TRUNK.PERMIT NO. ROAD PERMIT NO.
PRIVATE C 5 OSAL SYSTEM 1 'f_
I CONNECT ADDITIONAL -- _ _ t AFpIQpVl7 'h.4l4ER� EA"fMs!tT RECORD. INSTR NO DATE
4._ORK TO DOUSE'SEWER
-
OVERFLOW SEEPAGEPI.,DRA.NFIELD _.- ".r.�'_-T-
EXTN.CES'PO-CJL.,DRZE:LL,MANHOLE @ $9.00 -
-.__.-_{ HWY.OR ST,WIDENING
ALTER,REPAIR OR ABANDON HOUSE --
SE4JER C)R DI POSAL SYSTEM @ $3.00
____- STATE ENCROACHMENT -
PERMiT NO
----'f------"---'--- --------------------"--- r---- INDUSTRIAL 7 I
WASTE APPROVAL. ..fes � _3 -._..
OWNER'SPERMIT $ 00 - _ CHARGES
T' q�g
AUTHORIZATION TOTAL FEE ) CONNECTION CHAIiGE FEE
-IHAVE AT THIS DATE A.CONTRACT WITH THEr;EREtN NAMED CON- REIMBURSEM E N7 PEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED F.X.iSTING DWELLING --- - ---- --- - � -`-
TO THE PJBLIC SEWER.. APPROVALS ALS DATE INSPECTOR S SIGNATURE
SK,NED THIS DAY OF �_ _„�_. _�i9"� ---- ---- ------.---- --- ----- .._— ----
OWNER ORkj . NEW HOUSE SEWER
OWNERS AGENT�: _ ?�='""!
--- ----- -' --
CONNECT ADDITIONAl-
BUILDING
LBUILDIN OR WO P K
DRESS -_.- --__.-,-_-___ SEPTIC TANK SFEP, PiT(5) j
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI5 APPLICATION AND/CJR DR.A ..
.NF1 _D !
AND 6TAT'E THAT THE ABOVE i5 CORRECT AND AGREE TO COMPLY _--_- -.----------.-..___."- -.__--�, --------
WITH AL.L. •COU vTYOFiDI NA N,':FS AND STATE LAWS REGULATING �-_---
PLUMBIN6 AND SEWERS. - C 5SPOOL %-; CRYW ELL
.HEREBY CERY155Y THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SE VIER OP
LIC,ENS.ECY A5 )vE3UiRED BY LOS ANGI.E5 COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM TH.E LEGAL 'OWNER OF,.AND IN'TEN0 70 - CT'---' 1-"---- --�--�-
DIbCONNEPLUG AND
RcTHFSIDE IN- Y £ Ai„OVE DESCRIBED RESIDENTIAL PROPERTY,
- ABANDON HOUSE SEWER r
SIGNATLI RE
OFPERMITTEE- BACKFILL SEPTIC TANKS
SEEP,PtT(S) ❑ CESSPOOLS [_J
VALIDATION ROBERT A. MOOD
SUPERVISING MECHANICAL. ENGINEER
CK. M.O. CASH
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78A842D APPLICATION FOR PERMIT 1
3&E-888 T1=55
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
�.ogo? ��.� lcIf ow Rd*
JOHN A. LAMBIE, COUNTY ENGINEER ADDRE - - --
'� CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY Tpmpie City, Calif
NEAREST
7D;ESC1IPTION
OR APPLICANT TO FILL IN CROSS T f n d
el
LEGAL
LOTNo. L OWNER c3„ C (�Y' U�iS1CuiC _
TRACT C ADDRESS _ 4�MAIL �briel blvd.
NO.OF BLDGS. 77��
SIZE OF LOT__ NOW ON LOT CITY Sqn Gabriel TEL. NO.A
USE OF
[AI
_-- - R ��1 DISTRICT NO. I GROUP i MAP
GS - CS�.�.€$�7.G�
BK PG
CTOR 7j r r lvl r ,- _
21 '4. �''�,5�;c`�.T','1.c` , Ave. ��yy CONNECTION' DATA
CITY Arcadia TEL. NO. yah 6r° SJ _STATION ' � �a DEPTH �4 a
--- - MANHOLE REFERENCE .- �r ,�s
z 7 [I STATE _- _i 'E 'G`d __ LOWER i
ATION N0.113613 dab 42
DESCRIPTION of 1voRx FEETYPE OF CONNECTIO LENGTH FROM
OUSE SEWER CONNECTING TO Y. CURB P.L. ML.TO P.L.BLIC SEWER @ $3.50, '�`PTIC TANK SEEPAf E PIT OR
TS AND/OR DRAINFIELD _ _ /r- $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD - P C. NO.
iI EXTN CESSPOOL,DRY VELL,MANNOL.E q( $2.00_-_ _- CO. IMP. NO, _._ __JOB N0.HOUSE SEWER CONNECTING TO --- __-1 - - -_—.
___
_ PRIVATE DISPOSAL SYSTEM_ [y) $1._00._1 L TRUNK PERMIT NO - ROAD PERMIT NO.,
ICONNECT ADDITIONAL BLDG OR -I i STATE ENCROACHMENT ----°
WORK—TO HOUSE-SEVIER ritl $1.o0 I PERMIT NO.,
ALTER,REPAIR OR ABANDON HOUSE - _r
_ I INDUSTRIAL
_....i-SOWER-OR DISPOSAL SYSTEM C3` .$1.00 1'lRSTE APPkdVAL
---- -- ----- --------
CHARGE <
__.-_ CONNECT[ CHARGE FEr ,
OWNER'S PERMIT f-- -- — �--- -'—
-------- 1- . 1 OU _
�- RE.iMBURSE.MEN'f'4EE ..�---- y_ '
AUTHORIZATION TOTAL FEE - - f-
I HAVE AT THIS LATE A CONTRACT WITH THE HEREIN NAMED CON• APPROVALS 4-""'j'"""'D'R'fF-�TT�SPECTOW`SSi.NtlA URE
-- — --- - r _77— - -- -'-
TRACTOR TO CONNECT THE ABOVE` DESCRIBED EXISTING DWPELLING { ,I r
TO THE PUBLIC. SEWER. NEW HOUSE SEWER
SIGNED THIS. _—DAY OF -.19_ CONNECT ADDITIONAL
OWNER OR BUILDtN`;OR WORK
OWNERS AGENT - - SEPTIC TANK,SEEP, PIT(S)
L
AND/OR DRA1NFi[LD._..EREBY A. K ,VJLEDGE THAT I HAVE READ THIS APPLICAf ON ESSPOOL❑ DRYWELLu S ATF Tk T THE ABOVE IS CORRECT AND AGREE T0. COMPLY ..__ _.. --..- _ _-----� --- ----ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER r EPAIR SEWER OR
BiN ND SEWERS, SEWAGE;ISPOSAL SYSTEMH REw CERTi1Y THAT I AM PROPERLY REGISTERED gND ORX15 D ,S Rr3UIREC BY LCS ANGELES C ,CNTY D STATE U, UISCONNECT PLUG AND
FORP 4 OR THAT I AM THE LEGAL OWNF.R- Ok THE ABOVE AR NDON HOUSE SEWERR,Y,ED RESPDENT, PROPERTY, UACKFIt GPT CTANKS ATURE • .� SEEP. PITS; C SSPOO LPERMITT - I I
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PL.e.G. INSPECTOR
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