HomeMy Public PortalAbout4327TEMPLE CITY BLVD_Sewer T•� I JI
iaA[a,aUe, APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFM SEWER-SEWAGE DISPOSAL
Deportment of CoYntt Engineer '
C(anti of Lw Angel„ BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATTD GRIFFIN SUPTOFOUILDRIO LOCALITY
LEGAL
FOR APPLICANT TO FILL CROSS ST
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DESCRIPTION LOT NO OWNER
BLOCK TRACT PAIL
ADDRES,
NO OF SLOGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP YAP
K PG
CONTRALTOS
ADDRESS, ' CONNECTION DATA
CITY EL NO STATION DEPTH
MANHOLE REFERENCE
01 COUNTY UPPER
��
REGISTRATION RO COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM /
PUBLIC SEWER @ f 3 50 Y % CURB P L Y L TOP L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR GRAINFIELD Q L 3 00
OVERFLOW SEEPAGE PIT GRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE ® $Z 00 CO IMP NO JOB NO 2,11
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 1 00 TRUNK PERMIT NO ROAD PERMIT NO
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $1 00 PERMIT NO '
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $100 WASTE APPROVAL - -
CHARGES
CONNECTION CHARGE FEE _
OWNERS PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIYBURSEYENT FEE
1 HAVE AT THIS DATE A CT WITH THE HEREIN NAMED CON- APPROVALS DATE 1 1 NATURE
TRACTOR TO CONNECT/ HE ABON DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWEEEEEEOppppp NEW HOUSE SEWER
SIGNED THIOAY Ig_ `
OWNER OR 11\\ p" BUNLDE X6 OR WORKCT -,
OWNERS AGExT CCK/ SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AY THE A OWNER OF THE ABOVE
DESCRIBED RESIDENT OPERTY BACKFILL SEPTIC TANKS[3
SIGNATURE SEEP PIT(5) ❑ CESSPOOLS❑
OF PERMITTEE
100111 IN
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLOD INSPECTOR
Y O LAfN
(�,'D2 3 2
8M AN 27 1 b 4.5 0