HomeMy Public PortalAbout5828 TEMPLE CITY BLVD_Sewer__ 7&E-6b69 it•S5 APPLICATION _ FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer y
County of Los Angeles BUILDING �'
ADDRESS -�� d..
JOHN A. LAMBIE, COUNTY ENGINEER --- —_ e — --
CASSAT"T D.GRIFFIN, SUP'T OF BUILDFNG - LOCALITY
FOR APPLICANT TO FILL_ IN NEAREST
- - CROSS ST._�
LEGAL ------ ------ -- ,r- --- - -j/ ---- - f --__
DESCRIPTION LOT NO. OWNER
.- _-- --- --- _ -. MAIL -
BLOCK TRACT ADDRESS
SIZE OF LOT N W ON LOT _ CITY ✓�-- ,. TEL, NO.
USE OF
BUILDINGS DISTRICT NO. ! GROUP MAP
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CONTRACTOR < fir_ - .r
COCTION DATA
ADDRESS
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CITY 1 � f __-T£L. N MANHOLE REFERENCE - UPPE.R:('
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REGI
STRAT.ION NO. IWf COUNTY --- ---
NO. i DESCRIPTION OF WORK FEE7 -------- - ------ - - - ---- -----
g HOUSE SEWER CONNECTINS TO T TYPE OF CONNEC7131�,,. ., LENGTH FROM F
- I .�..a ;-•'' Y, CURB P°'P L` M.L,TOP L.
I PUBLIC SEWER $3.50
SEPTIC TANK,SEEPAGE PIT OR I�
OVERFLOW
CESSPOOL, EL.L,NIA THOLE I<8 - - -�--
_ _ PITS AMD/OR DRAINFIELD ht $3._00
� � _ S 2..00CO. ]MP NO, -�"� �a- 10H "x0,
HOUSE SEWER CONNECTING TO -- -- -
PRIVATE DISPOSAL SYSTEM a $1. N
00 I 'RUNK PERMIT NO. ROAD PERMIT O. -
--- ------------L S -
i CONNECT ADDITIONAL BLDG.OR ! STATE ENCROACHMENT
WORK TO HOUSE SEWER r•'E $E.UO ---_ ._ PERMITNO,
ALTER,REPAIR OR ABANDON HOUSE ._._
SEWER OR DISPOSAL SYSTEM r� INDUSTRIAL
--,. .—...—__.._.-_ �1_00 L-�---.---- WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE.
OWNER'S PERMIT
AUTHORIZATION T®TAL FEE � �� 0�- REIMBURSEMENT FEE
APPROVALS ATE IINSPE CTOR s !GNATURE
I HAVE AT.THIS DATE A CONTRACT WITH THE HEREIN NA EII CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED ERIS'TANG DWELLING
T
TO 1HE PUBLIC SEWER. NEW HOUSE SEWER i T
SIGNED T1i1S _._y-.-...DAY OF y 19— ONNEC7 AD ;TIONAL - -y-- -
OWNER OR AtO 1`� " BUIL_D NC OR WORK _
OWNERS AGENT ._'=.-t,.4�.-� ,- $�- ` SEPTIC TANK,SEEP, IT(S1
�.t �41 - s AND/OR DRAINFiELD '
ADDRESS
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS API KATIONT
CESSPOOL[j DRYWF.LL LJ
AND STATE THAT THE ABOVE IS CORRECT AND AGREE, TO COMPLY --- I ---_-_L_----
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEINER OR '
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REG 7ERED AND/OR ABANDON DISCONNECT AND
PLUG
LICENSED AS REQUIRED BY LOS ANG E COUI AND STATE OF CT PHOULUGEW D
CALLFORNIA OR THAT 1 AM THE LEb OW P. OF THE ABOVE -- ---- -ER --- --- ---
DESCRIBED RESIDENT]AePROPERTY, BACKFILL SEPTIC TANKS
—EE- ❑ �—
SIGNATURE J SP.PIT(S) LI_ CESSPOOLS LI ---' -- _. --__--
OF PERMITT -- - -- --.—.-..-�
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JOHN A. LAMBIE.Co YY ENGINEER IDATION ROBERT A.WOOL}, CHIEF PLBG. INSPECTOR
(CASH