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HomeMy Public PortalAbout5428 TEMPLE CITY BLVD_Sewer__ 70AG4,,,,BeAPPLICATION FOR PERMIT 1 DMSION'OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Depmtnant of County Engln"a County of Los Angel" BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS ® OASSATTO GRIFFIN SUPTOPBUILDINO LOCALITY F B LICANT TO FA/LL IN CRos"BE'sTLEGAL f o WI i� DESCRIPTION L T NO y OWNER Q�' MAIL BLOCK TRACT ADDRESSZ 7X ,PCG L L NO OF SLOSS CITY TEL NO SIZE OF LOT NOW ON LOT USE DI fTRUNX STRICT NO GROUP YAP USE BUILDINGS BR PG CONTRACTOR ADDRESS D / COIRMCTTON DATA CITY Q TEL NO / / TION SS/ 3 DEPTH HOLEREF ENCR UPPER STLOWER REGISTRATION NO / 4 ❑ COO �JNo DESCRIPTION OFWO K FEEHOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3 SO CURB P L Y L TOPL SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD ® S S 00 OVERFLOW SEEPAGE PIT DRAT NFIELDP C NO fiXTN CESSPOOL ORYWELL MANHOLE S 2 00 IMP NO JOB NO HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM ® 91 00 PERMIT NO ROAD PERMIT NO CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER S 100 ]REGULATING PERMIT NO ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM 1 00WASTE APP AL HARGFS CON IE ION CHARGE FEE OWNER'S PEDW s0 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N � �V�"g DATE INSPECTOR 98IGRA7URE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINNG TO THE PUBLIC SEWER NEW HOUSE SEWER •- SIGNED THIS DAY OF CONNECT ADDITIONAL 11�� OWNER OR BUILDING OR WORK I �p OWNERS AGENT SEPTICTANK SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS ON CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREELY WITH ALL COUNTY ORDINANCES AND STATE LAWS NG ALTER,REPAIR SEWER OR PLUMBING AND SEW0,T11 SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFYPROPERLY REGISTERLICENSED AD REQUIRNGELES C GI AOF 018COMNECT PLUG ANO CALIFORNIA OR TNALEGAL ER VE ABANDON ROUSE SEWER DESCRIBED RESIDENTBACSEEP FILLPIT SEPTIC CTANKS0❑ SIGNATURE �' OF PERMITTEE IP JOHN A LAMBIE COUNTY ENGINEERMMATIOw� ROBERT A WOOD CHIEF PLBG INSPECTOR ■ a LrA0725MMAY 9 4A 2_ .00- X - _ _ _