HomeMy Public PortalAbout10939 WILDFLOWER RD_Sewer__ PeAe4:f°
P-863 14.55 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 �yy O .
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS y O ,A"il ,,f l,Ot er Rt.
CASSATT D. GRIFFIN,.SUPT of BUILDING LOCALITY Temple City
AREST
FOR APPLICANT NE
_INT TO FILL IN cRoss sTT.1flf
e l aL'±d Ave�
LEGAL
DESCRIPTION LOT NO. OWNER J I }o Q()r`ct1;r s f o�MAIL
(�71
BLOCK TRACT 23949 - ADDRESS _272 Y2 San Gabriel Blvd.
-__ - NO'OF BLDGS. CITY '� TEL. N0.
SIZE OF LOT .NOW ON LOT 4S`�
BOF
UIELDINGS ' DISTRICT No. f GROUP MAP
— L. i� w BK PG
CONTRACTOR L. D. Ii W e✓(jrj,u"l;ruct,ion Col —
g� I*`° CONNECTION DATA
ADDRESS �� IFV� YV�.,srr'�C���.� ���i•
v'P r� °') 4? —STATIONS _ DEPTH
CITY Arcadia TEL.N0. V® 238
---- ---.-- MANHOLE REE�E `„p. UPPER
❑ STATE e ^
REGISTRATION NO, ?j Q 42 Y
NO_i DESCRIPTION OF WORK TEE
TYPE OF CONNEC7I0 LENGTH FROM
HOUSE SEWER CONNECTING TO - - ' 50 - y CURB— P.L. M.L.TO P.L. "
J PUBLIC SAYER _ @ s 3.50 - -SEPTIC TANK,TANK,SEEPAGE PIT OR �- -
PITS ANDrOR DRAINFIELD _�< $3Ap( --
i OVERFLOW SEEPAGE PIT,DRAINFIELD I P C. NO. ,ym
EXT`Y.,CESSPOOLDRYWELL,MANHOLE of $t,pp! CO. IMP N0, JDB NO,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM CT, s 1,30 -TRUNK PERMIT NO, ROAD PERMIT N0,
CONNECT ADDITIONAL BLDG,OR I STATE ENCROACHMENT
WORK TO HOUSE SEWER _ �r S;.DG PERMIT NO:
ALTER,REPAIR ORABAND ON Ht3USE INDUSTRIAL
_ I-StWER OR-DI DISPOSAL SYSTEM _-_lrz S I_.0 i -� _- WASTE kPPROVA,. -
_� I CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT - —
AUTHORIZATION --TOTAL FEE-���-- 11�Do REIMBURSEMENT FEE— --- ----- _----
'- �a[� a
APPRO ALS I DATE i NSPEC'iOR SIGNATURE
I
HAVE AT THIS DATE. A CONTRACT WITH THE HEREIN .NAMtED CON- ---_—.._-----
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUPLIC SEWER. ihW HOUSE SEWER
SIGNED THIS___. _..DAY OF _ _--19CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS
ACENT,�_ -- SEPTIC
.. _._ ..--- --I --- -_----
SEPTT IC TAMC,SEEP. Ptl"fS;
ADDRESS -_-W_. ND/UR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLC.] DRYWELLO
.AND STATE ,'r.-.? H'r. ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND S'iATE LAWS REGULATING ALTER,REPAIR,SEWER OR i
PLUMBING AI4D SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND �-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND Sr,ATE OF
CALIFORNIA OR TT R_T 1 AMTHE LE:� ABANDON OWNER OF THE AB09E ,u _`'
DO HOUSE W'
S ER i
DESCRIBED RESID "IAL PROP° R Y, -�-�' 7 BACKFILL SEPI(C TANKS
.,' SziP. PIT(S) LI CESSPOOLS;—
SIGNATURE _.-"_- - -'-- - ---__ ._--------. ___.----_.—__.------
OF PERM.I - . __ C
JOHN A, LAMBIE, COUNTY EN NEER VALIDATION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR
6KI N, O. CASH -
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