Loading...
HomeMy Public PortalAbout5749 TEMPLE CITY BLVD_Sewer__ D 5&E-6S3 IP•S5 APPLICATION FOR PERMIT 1 3 Bc -S DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDIN JOHN A. L AMBIE, COUNTY ENGINEER AD4RESS, CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITA NEAREST _ OR APPLICANT TO FILL IN _ _CROSS ST. LEGAL r pESCRIPTION LOT NO ✓ t^ :-`�t��3 'G F. ` GWNE_R a�" dz'=" MAIL BLOCK TRACT f'-. ---------- --ADDRESS „9t-0_SDF BL4GS. – _._---. r SIZE OF LOT - rJ ,r .NOW ON LOT CITY s.yx � s _EL. NA. ✓saaL% . USE OF ��"� BU6LDINGSi 'SI'ad'•ze�:r DISTRICT NO. GROUP. MAP BK PC CONTRACTOR y _ g4..,•'f ..-+��' -' •, ;•"q,,,. I, - "' CONNECTION DATA ADDRESS ` STATION _ _–j DEPTH CITY TEL.NO. OY; dyt MANHOLE REFERENCE STATE -, ,3 ` 6yy t,. �:_ ❑ ---._.__._----------- .. — REGISTRATION NO, p � ❑ COUNTY NO. 1 DESCRIPTION OF WORK YEE _.----.— - — ------- -- --- HOUSE SEWER CONNhC71NG TO ----- ,...� i LENTH FROM Y TYPE OF U 7IONP.L. M.LGTO P.L. PUBLIC SEWER @Tu $3,50 ---� SEPTIC TANK SEEPAGE PIT OR - ----^ –_.-- –T-- PlTS AND/OR llR_AINFIEL_D fry$3.00: I OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO, XTN.,CESSPOOL,DRYNELL,MANHOLE Q $2.001 ----- CO. IMP. NO. 'JOB NO. E — —�— _ I PRIVATE DISPOSAL SYSTEM _ a, 1 I TRUNK PERMIT NO. ROA4P_E_R_MST'NO. — — HOUS..SEV�'ER CONNECTING T3 Y � —, - I.00 _ CONNECT vD DITIOP AL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEVOER - (*�; $I.00 I _ PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE I - OR DISPOSAL SY5IEM cal $I.00 INDUSTRIAL _— i -- I WASTE APPROVAL - ( — CHARGES -------_-----._)__ __ CONNECTION CHARGE FEE OWNER'S PERr.'IIT - $ 1 00 REIMBURSEMENT FEE AUTI'dORIZA'TICZN TOTAL FEE --�- 1-� s7 APPROVALS DATErldsPEcroR'sslGNATtRE I HAVE f.T' THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- I ITRACTOR Tj : Ci'NECT THE ABOVE DESCRIBED EXISTING DWELLING 7'0 THE PUB11C WER. : � ,r� � - NEW I90U5E SEWER SIGNED TH1 DAY OF `� _.19 ` -} -- CONNECT ADDITIONAL OWNER OR A BUILDING OR WORK OWNERS —.. —��.. NIRS AGENT "_ :�. 4.rT_._ SEPTIC TANK,SEEP, PIT(S) ! -- I{ ---s---- .ADDRESS X� __.1.._€LfD'_> -.� .. AND,'4R UR i*_LD ._. I HEREET .ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL L-I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ----_..-_-��------_- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLU N,.EING ;AND SEWEP.S. SEWAGE DISPOSAL SYSTEM FLRCb''! CERTIFY 'I H.A7 ! AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND j LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE A BANDON HOUSE SEWER - DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEP-FIC TANKS El SEEP. PIT(S) J CESSPOOLS Lt SIGNATURE _�_-----=— OF PERMITTEE i JOHN A. LAMBIE,COUNTY ENGINEER VALIDATIOX ROBERT A.WOOD, C!'IIEF'PLBG. INSPECTOR CK. N.U_ CASH) -