HomeMy Public PortalAbout4946 WILLMONTE AVE_Sewer__ TEMPLE CITY
:EBUR 12-68 APPLICATIONS FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRE
DING nT. i1�1U21D Ave*
JOHN A. LAMBIE, COUNTY ENGINEER SS 4946,
COLEMAN W. JENKINS. SUPT. OF BUILDINGLITV g`SNEARESST.L.�,}'1 er Azusa lid►
FOR APPLICANT TO FILL IN - Bowen
LEGAL �.':Yir3 `t .
DESCRIPTION LOT NO. MAIL
OWNER +''),n, Melanie '{'
BLOCK TRACT j• '`- ADDRESS !620 MLn.
NO: OF HLDGS. �j,
SIZE OF LOT NOW ON LOT CITY Arcadia TEL. NO. yl�,T *.%`�"`
USE OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS Re,r,,,`r
BK PG
CONTRACTOR w3 LZCaI�e Deal Sewer
�.C�
2933 �Tt'..xson E.d. CONNECTION DATA _
ADDRESS /� (� ! ---
CITY qi Monte I' ,-2?02V STATION- /` - DEPTH !¢
TEL. NO. /
STATE 1 288-"� LIC C-4-�' MANHOLE REFERENCE � ., LOWER
LICENSE NO: .�,4,i Ci t_V CLASS �I.dd 4. l� 4�.
NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION --. '� LENGTH FROM '
HOUSE SEWER CONNECTING TO --r �'I Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $3.00 J 'AJ - P.C.NO.
SEPTIC TANK,SY.--PAG- CO.IMP.
E PIT OR NO.
,I 'l' -JOB NO.
PITS AND/OR DRAINFIELD $10.00 II l _
HOUSEE
SWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (L
1 PRIVATE DISPOSAL SYSTEM � $3.00 _ -_ _ Oi
CONNECT ADDITIONAL BLDG.OR _
+ AFFIDAVIT NAIv[ Y[tIT RECORD.INSTR.NO. DATE U
WORK TO HOUSE SEWER
__i-__.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL.MANHOLE Q $5.00 ~
ALTER.REPAIR OR ABA ND07J W
HOUSE -_I�- HWY.OR ST.WIDENING _- V
SEWER OR DISPOSAL SYSTEM _ $3.00_ _ __ STATE ENCROACHMENT ~�
� PERMIT NO. �
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMITsem—o — -
AUTHORIZATION TOTAL. FEE 00 CONNECTION CHARGE IEE — ---�__
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE {rATE -
TRACTOR TCONNECT THE ABOVE DESCRIBED EXISTING DWELLING T APPROVALS
TO THE P0.UBLIC SEWER. . INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_. ---__-- � '_ --
NEW HOUSE SEWER
OWNER OR
OWNERS AGENT_ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS-__ -- .
-
S
--- - EPTIC TANK.SEEP.PITS)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY ---
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ElDRYWELL [3PLIJ MB
AND SEWERS. __ ------'
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE LEGAL OWN E R�OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOYE DESCRIBED RESIOEN AL pJROPERTY. AgpN DON HOUSE SEWER
SIGNATURE +'� '-�.A/� „A' BACKFILL SEPTIC TANKS ❑
Of PERMh'TEE� '"� --------- SEEP.PIT
❑ CESSPOOLS ❑I
-KD
JACK R. ALLEN M.O. CASH
SUPERVISING MECHANICAL ENGINEER
CK.
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