HomeMy Public PortalAbout5703 TEMPLE CITY BLVD_Sewer__ TYAS420 APPLICATION FOR PERMIT 1
•sceaDlIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
DepartnLent o/ County Englnsm
County of Lw Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS -
® CASSATTD GRIFFIN SUPTOFSUILD1N0 LOCALITYA CJ
NEAREST
FOR APPLICANT i0 C OSS 9T /
LEGAL OWNER DESCRIPTION LOT NO
MAIL
BLOCK TRACT ADDRES
NO OF SLOGS CITY C• TEL NO
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP YAP ,
SUILOINGB
��1 SK PG
CONTRACTOR f/• 4- 1
CONNECTION DATA
ADDRESS /
/ STATION DEPTH
CITY 4176
TEL NO
MANHOLE REFERENCE _ UPPER
STATE
REGISTRATION NO ❑ COUNTY Af 7
NO DESCRIPTION OF'WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF INE X LENGTH FROM
PUBLIC SEWER ® $3 SO T RB P L Y L TOP L
SEPTIC TANK SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD ® $3 00
OVERFLOW SEEPAGE PIT DRAINFIELDP C NO
ERTN CESSPOOL ORYWELL,YANHOLE ® S E 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $1 00 PERMIT NO _
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMT s 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE REIN AY D CON- APPROVALS DATE IN9PEC 991 TORE
TRACTOR TO CONNECT THE ABOVE DES R[BED EXISTING DWELLING
TO THE PUBLICS NEW
W HOUSE SEWER !
SIGNEDTHIS OF 1 CONNECT ADDITIONAL
OWNER OR tf BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACIN LED E THAT AY D TfAlf APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS COBRjICT AND )fGjfEE TO COMPLY
WITH ALL COUNTY ORDINANCES AIM STATE 6WS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWER$ SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUS AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND ATE OF ABANDON HOUSE SEWER
CALIF NIA OR T 1 Ma OWN F T
DES CRI ityJlD J BACKFILLSEPTIC TANKS❑
SIGNA J SEEP PITS) ❑ CESSPOOLS
OF PER YITTEE
JOHN A LAMEIM COUNT! ENGINEER �- VALIDATI ROBERT A WOOD C, r PL8O 1NSPBcs
CR Y 0OATH
"moo" IIJU'10_ a e 450
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