HomeMy Public PortalAbout10919 WILDFLOWER RD_Sewer__ 76AS420
&E-663 11-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER --ADDRESS 10 11 i i d-f i owe r Rd.
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Tempie City, Calif .
NEAREST
FOR APPLICANT TO FILL IN CROSg ST,4;Iel-.Land Ave.
LEGAL
D L
S IPTION Webor Uonstruction
LEGAL
7_ESCRIPTION LOT NO., 4 011E,
MAIL
BLOCK TRACT 23949 ADDRESS 272 Y2 San Gabriel Blvd.
NO OF BLDGS.
SIZE OF LOT NOW ON LOT CITY San GabriejTEL. NO. A�t r,7-0
USE OLDINCS F OUP
lesidence DISTRICT NO. GR MAP
BK PG
CONTRACTOR L* D.& M. Uon'—struction CO
CONNECTION DATA
ADDRESS 2-1
day CONNECTION
_STATION -1�1 4-. DEPTH
,CITY
MANHOLE REFERENCE
Ll STATE /LOWER
REGISTRATION NO. 113513__ C 42
DESCRIPTION OF WORK FEE
ND_ DESCRIPTION
OF CONNECTIOV,?- '- LENGTH FROM
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ 3.50 � Y. CURB P.L M.L.TO P.L.SEPTIC Jv
`
TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD
$3.001, 4
P. C' NO.
OVERFLOW ERFLOW SEEPAGE PIT, DRAINFIELD Co. IMP. NO. JOB No.
EXrN-CESSPCO L,DRYWELL.MANHOLE (4) 15 2.00
HOUSE SEWER CONNECTING'f0
PRIVATE DISPOSAL SYSTEMco $1.00 TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
C,
WORK TO HOUSE SEWER 0_, $1.00 1 PERMIT NO,
ALTER,REPAIR OR ABANDON HOUSEINDUSTRIAL
SEWER OR DISPOSAL SYSTEM. 1.00
---------- WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 1 00 REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 4.510—
APPROVALS DATE !INSP-CTOR'SSIGNATUPE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COIN-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWZJR. NEW HOUSE SEWER _ illi
SIGNED THIS--.--.--DAY OF_____. 19_ CONNECT ADDITIONAL
OWNER OR B_UiLDING OR WORK
OWNERS AGENT— SEPTIC TANK,SEEP,PIT;,S)
AND/CRDRAINVFLU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION j L 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL EDRYWEL
-
WITH ALL COUNTY ORDINANCCS AND STATE LAWS REGULAT)NG ALTER,REPAIR.SEWER OR
PLUMBING A14D SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREEYCERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
L'1CEN AS R.FrJUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR TJ`
I AM THE LEGAL qjwwrP,• bF THE ABOVE ABANDON HOUSE.SEWER !
BACKFILL SEPTIC TANKS 0
DESCRIBED RES!DENM.�,L PROPERTY~
SIGNATURE SEEP- PIT.(S) L2 CESSPOOLS f-1
OF P E R M I r T Jlivu-/.t
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLE;G. INSPECTOR
'CK. X. 0. GAgH
r�; La