HomeMy Public PortalAbout5423 ROBINHOOD AVE_Sewer__ Sla"ott-.e
APPLICATION FOR PERMIT 1
■r .
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DIS POS"L .
D%-rW- 3 of Coont7 EnghumCo= A
JOHNA. MBIEof LC�OULENOiNEER ADDRESSGN54O AVBII11e
m CA.ssATT D. OftIF71N, HUP•T OF BUILDING LOCALITYTemple City .
FOR APPLICANT TO FILL IN c ouREST live Street
LEGAL - OWNER TolinDESCRIPTIOX LOT NO.
n, ^0N MAIL O QitrUB Avenue
-
BLOCK TRACT G.�rll't' ADDRESS
N0.OF BLDGS.
SIZE OF LOT NOW OR LOT CITY Covina TIL. X0.
UI OFLDINGII
BDISMCT NO. GROUP YAP
UI
<—� PG
coXTRACToR L &M. ConstPuction Gio.
ADDRESS P. 0♦ BOX 208 CONNECTION DATA -
CITY Baldwin Park-RL. No.ED 8-3024 'STATION DEPTH '
MANHOLE REFERENCY .lUPPER
STATE
REGISTRATION N0, ll (0 3 COUNTY
No. DESCRIPTION OF WORK FH>i
HOUSE SEVER COXXE XG TO I TYPE OF CONNECTIO LE pTl{FROM
PUBLIC SEVER B 3.50 Y. CURB Y.L.TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 9 .00
OVMUrLOW SEEPAGE PIT,DRAHIFIELD P. C. No.
EKTX. CEIISPOOL DRYMELL MANHOLE 2.00 CO. IIP.-NO. JOB NO.
OUSE HEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR iTATE ENCROACHMENT
WORK TO HOUSE SEVER 1.00 PERMIT N0.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM $1.0.0 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s 00
AUTHORIZATION I
TOTAL Fn4prA0REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HB>tEIN NAY ED CON- AOVALS TB INSPE RSSIGXATURE
TRACTOR TO CONNECT.THE ABOVE DESCRIBED ExISTINB SMELPPR
LING
TO THE PUBLIC SEWER. NEN H0L3E SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIp XAL
OWNER OR Eek BUILDINWOR WO
hK
OWNERS AGR)(T 11 9EFT ICTANK,3EEP,PIT(S)
ADDR AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDIRAXCE.S AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. II AGE DISPOSAL SYSTEM
I HgREBY CERTIFY THAT I AY PROPERLY REBISTYRED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY L03 ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AN THE 194AL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL OPERI BACKFILL SEPTIC TANKS❑
/I9N TURE SEEP.PIT(S) ❑ CEIISP00 El
OF PQtY1TTEE
442;p PIP 1 0
JOHN A. LAMBIE. CoUN7Y oINEER VALIDATION ROBERT A.WOOD,CHIE1<PLBO. INSP3.CTOR
( 1 3 5 4 OR OAC 26 1 0 A 5.00 A