HomeMy Public PortalAbout5434 ROBINHOOD AVE_Sewer__ r
:;4e"ll-as APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
D*paxnImat of County Enghum .
A
JOHN A.LAMBIEof LCOU�•EN6INQER `5434 m bi hood veI1�,L' e
CASSfATT D. GRIP'FIN, GUF'T OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN CRROSS SST. Olive Street
LEGAL
DESCRIPTION LOT NO.
1AIL A
BLQCK TRACT 21704- ADDRESS it AY
n0.OF BLDG9. fD
TEL. NO.
917E OF LOT NOW ON LOT
UDE OF NO. GROUP MAP
BUILDINGS__
B PO
cOXT4ACTOR 577
ADDRMi. CONIN + ION DAr1�l
C1T�dwin Park raL. NO. 021.
STATION d DEPTH
EFI'1tfiNCE11 61 STATERYGIST'RATIOX XO, 3 3 ❑ COUNNO. DESCRIPTION OF WORK FEE of coXNHcrIo LEIIGTfl Fi�OYflOUSH DEWHR CONNECTING TO CURB P. Y.L.TO P.L.
PUBLIC'SEWER @ 5.90 _
SEPTIC TANK,SEEPAGE PIT OR
PITS-AMD/OR DRAINFIELD 5.00
OVERFLOW 9 GII PIT.DRAINFIfiLD P. C. N0,
EXTN.,CEaaPOOL DRYWHLL MANHOLE 2.00 CO. Imp,N0. JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S 1.00 URK FERYIT NO. ROAD-PERMIT NO.
CONNECT ADDITIONAL BLD4.OR 9TATE ENCROACHMENT
WORK TO HOUSE SEWER $1.00 PER IT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 40 jI.0'O RASTs APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNEB`8 MMIT t 00
AUTHORIZATION rOTAI, Fgg REIMBURSEMENT FEE �
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS D TE INDPE OR'881GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING PlNE"ING
TO THE PUBLIC SEWER, igLw HOUSE SHIVER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
0*NER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SKEP,PIT(S)
ADDRESS AILD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HERH9Y CERTIFY THAT I AY PROPERLY REGISTERED AMD/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ELED COUNTY AND STATE OF DISCO N HOUSED AND
CALIFORNIA OR THAT Aid GAL OWNER OF THE ABOYE
WER
DESCRIBED RESIDER _ BACKFILL DElj_ic rAXKS❑
SIGNATURE S9Rr.PIT a ❑ CESSPOOLS❑
OF PERMITTEE -
JOHN A. LAMBIE,COON NGINKER VALIDATION ROBERT A.WOOD,CHIRP PL.BG. INBPa.cTOR
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