HomeMy Public PortalAbout5733-5735 TEMPLE CITY BLVD_Sewer__ r$aE66
E.-669 14.55 FOR R PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County ]Engineer
County of Las Angeles BUILDING E
ADDRESS
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JOHN A. LAMBIE, COuftTY ENGINEER
CAS:SA'TT D. GRIFFIN. SUPT OF BUILDING LOCALITY
FOR APPLICANT` TO FILL IN CRROSS ST. J -
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LEGnL— _
DESCR,PTION� LCT NO. OWNEk+ ! y'+�s'i -
MAIL
BLOCK TRACT ADDRESS
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NO. OF BLDG:S, tib. CITY ,r �,�, ., TEL. NO.,y""
SIZE OF LOT ;.- �', NOW ON Ll Tf
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USE OF
BUILDINGS ;;: ._ ., DISTRICT -O GROUP MAP
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CONTRACTOR
r - NNE A -
ADDRESS
�`_�^'___ F ----- - CONNECTION DATA- -
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STATION
TEL. NO,/- - --- — --- - --
MANHOLE REFERENCE `-I UP
} CZ EI COUNTY
-- ------'— -STRkitUN h0
NnCI' D SCRIPTION OFWORK FEE
-� -- - --- ------ TYPE OF TIQN LENGTH FROM
"I
SEWER CONNECTING TO -
PUSLICSEWER @ $.$,50' I �.�. Y.
-SEPTIC TANK,SEEPAGE PIT OR
-�( PIIS ANDIO s D[tAINFIELD of $3.00 I — - ----- ---�
OVERFLOW SEEPAGE PIT,DRAINFIELD ! P C N0,
--.j- FXeN.,GLSzPOOL;DRYWELL,MAM%IOLE �t) $.2.00! -C IM NO. . �a )O6 NO.
-
HOUSE SEWER C ONNECTING TC) -
PRIVATE DISPOSAL SYSTEM (c_ $1.00 _ ' BUNK PERMIT NO -- ROAD PERMIT N0. - .
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CONNECT ADDiT ONAL D: OR -- ! STATE ENCROACHMENT
WORK TO IIOUSI. SEWER C $I.OD } .i..�.. F ERMIT No
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER:OR DISPOSAL SYSTEM t+ S 1.00 .._ 1 WASTE APPROVAL -
i
CHARGES
-- -- _.--- _- CONNECTION CHARGE FEE
OWNER'S PERMT ---5 ±1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
APPROVALS DAT �INSPECTOR'S SIGNATURE
I HALVEATTHIS DATE A CONTRACT WITH THE HEREIN NAMED CON- — —..---_-----__._.---I
TRACTOR TO CONNECT THE, ABOVE DESCRIBED EXISTING_ DWELLING . .,.
TO THE PUBLIC �EW'ER, NEW HOUSE SEWER
SIGNED THIS DAA QF 1� CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG#:NT
fd >... .
SEPTI^TANK SEEP,PIT(S1
ADDRESS. ":_ . -au 3, AND/OR DRA:INFIEe D ---
i HFREBY ACKNOWLEDGE; TH- I ..HAVE RCA.D THIS APPLICATION CESSPOOL,[-] DRYINELLL.,
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 HERELY CERTIFY THAT I AM PROPERLY REGISTERED AN Di`OR �DISCONNECT PLUG AND ^— ----
LICENSED AS REQUIRFL BY LOS ANGELES COUNTY AND STATE OF ABANDON I1 tiiUSE�_+5"FR '
Ce..LI.FORN[A G THAT a AM TNF LEi>:AL OWNER
OF Tt E ABOVE ABANDON
-. '.--------fi —-----._
DESCRIBED RESIDENTIAL PROPERTY. BACKFILLS
CESSPOOLSSIGNATURE
OF PERMITTEE
1
JOHN A. LAMBIE.COUNTY ENGIN-EER VALIDATIO ,'"' ROBERT A.WOOD,CHIEF PLBC. INSPE.CTOP