HomeMy Public PortalAbout6336 TEMPLE CITY BLVD_Sewer__ .:[:i 11 BR APPLICATION FOR PERMIT 1
DIVISION OF BUU.DMG AND SAFM SEWER-SEWAGE DISPOSAL
Depmrmunt of County Engles
County of Lm Angela eU11Dln6 3
JOHN A LAMBIE, COUNTY ENGINEER AOORE49
m CASSATT D GRIFFIN SUP T OF BUILDING LOCALITT
NKAREST
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LEGAL fT 07- OWNER
DESCRIPTION LOT NO
MAIL
BLOCK TRACT4..vj ADDRESS
0 OF
SIZE OF LOT NOW ON LOTS CITY TEL MO'4 T�wl 9z 1!5ti
USE OF
BUILDINGS I DISTRICT NO GROUP MAP
I � _BR p6
CONTRACTOR
ADDRESS 2 CONNECTION DATA
CITY TEL NO T STATION p DEPTH '
MANHOLE RE ENCE
Cor STATE LOWER
REGISTRATION R LJ COUNTY
NO DESCRIPTION F W RK FEE
ROUSE SEWER CONNECTING TO TYPE OF ION LENGTH FROM
PUBLIC SEWER ® $3 50 _ Y URB P L M L TO P L
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR GRAINFIELD S 3 00
OVERFLOW SEEPAGE PIT URAINFIELD P C NO
EKTN CESSPOOL DRYWELL MANHOLE ® S 2 00 CO IMP N� JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO -ROAD PERMIT NO
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® $1 00 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 1 GO WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT f 1 00 REIMBURSEMENT FEE
RUYIiORIZATION TOTAL FEE (j
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS GATE INSPECTOR 9SI0NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS AY OF 19_ CONNECT ADDITIONAL
OWNER OR �b BUILDING OR WORK
OWNERS AGENT �(J� SEPTIC TANK SEEP, PIT(S)
ADDRESS AMD/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT D
PLUG AN
LICENSED AS REQUIRED BY LOS ANGELES COUN ND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA OR THAT I AM THE LEG OW OF THE ABOVE
ER
DESCRIBED RESIDENTI ROPERTYERMI BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) C3CESSPOOLS
OF TURF
JOHN A LAMBIE C&&TY ENGINEER VALIDATIONS ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M
0
35 0€R M 1L3 _� ; /450 9