HomeMy Public PortalAbout10915 WILDFLOWER RD_Sewer__ 76A6420
E-Ger APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dep=trnent of County Engineer
County of Los Angeles BUILDING
_ADDRESS 10915 Wildflower Ad.
JOHN A. LAMBIE, COUNTY ENGINEER
t CASSATT r). GRIFFIN. SUPT OF BUILDING LOCALITY Tegxple City, Calif
APPLICANT TO FILL IN NEAREST
CROSS
ST. 14 e-1
LEGAL
DESCRIPTION LOT NO. OWNER J.. B, giber Constructi on. Q
BLOCK TRACT MAIL
ADDRF
2?2 3,n Gabriel BlVd.
NO. OF BLDGSX= 2 CITYSan Gabriel ,TEL. No. At ?-05 31
SIZE OIfLOT NOW ON LOT
USE OF
BUILDINGS Rezidenrne- DISTRICT NO. GROUP BK MAP PG
CONTRACTOR L. D. 21. Construction Co
AC0NXECTI6—NA
DAT --------
ADDRESS 21 Wr-i
. 'Nistaa X�.Ve.
STATION DEPTH
CITY 'q-I i 'q TEL-NO Hi P 8 MANHOLE REFERENCE
REGISTRATION NO. o UPPER
113613 C 42 0 STATE :3
NO. ! DESCRIPTION OF WORK FEE
TYPE OF CONNECTION_ LENGTH FROM
HOUSE SEWER CONNECTING TO ",r
M.L.TO P.L.
I PUBLIC SEWER @ $3.50 3-50 Y CURB
I SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIN FIELD (ap, $3'.11
OVERFLOW SEEPAGE PIT, DRAINFIELD P.
C.
C NO,
EX1 N.,CESSPOOL,DRYWELL,MAN HOLE $2.00 CO, IMP, NO, JOB .
HOUSE SEWER CONNECTING TO
PRIVAT�DIS POSAL SYSTEM $1.0 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT
I WORK TO HOUSE SEWER ca 1
.$ 00 1 L PERMIT NO,
-1 ALTER,REPAIR.OR ABANDON HOUSE INDUSTAPPIAL
SEWER-OR-D*I-SPOSAL-SYSTEM--- ---- (iZ v-.-0-a–1, WASTE ROVAL
CHARGES
J I
CONNECTION CHARGE FEE
OWNER'S
PERMIT 5 1 11 00
I --------
.--- REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE 4;50
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN APPROVALS DATE INSPECTOR'S 5 C NATURE
NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXiST(NG DWELLING
TO T14E PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS-----DAY CONNECT ADDITIONAL
OWNER OR BUILDING OR'
OWNERS AGENT__—�--__ SEPTIC TANK.SEEP,PITfS)
A D 1)Rk CSS-- )/OR DRAiNF117LD
I HEREBY ACKU'QViLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL DRYWELLO
AND STATE THAI' THE ABOVE IS CORRECT AG
,AND AREE To COMPLY
V.I_H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEVVERS. SEWAGE DISPOSAL SYSTEM I
HER-,3Y CERTIFY Ihtk7 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
IENSED AS REGUIRED BA.
Y LOS NGE LES JC Y AND STATE OF
CALIFORNIA OR THAT I AM THE LEG',�J�0, N T
ER OF THE ABOVE ABANDON HOUSE'SEWER
DESCRIBED RESIDENT_4L PROPERTY 'XI'. BACKFILL SEPTIC TANKS LEI
SIGNATURE SEEP. PIT(S� 0 CESSPOOL$
--- --------
OF PERMITTE
JOHN A. LAMBIE,COUNTY ENG; ER �>YALTDATION ROBER'r A. WOOD, CHIEF PLBG. INSPECTOR
M. G. CASH
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