HomeMy Public PortalAbout4327TEMPLE CITY BLVD_Sewer (2) CE60610-69
7GA642D APPLICATION� R PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDUM AND SAFETY DIVISION RR
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DESCRIPTION LOT RO �(J / //�y�/l �/AJ{ �J /L p•
[LOCK TRACT SS 2j CO ✓✓ ♦ E✓� v�L 416
NO OF SLOGS
SIZE OF LOT NOW ON LOT B EL NO
US[ OFCT NO GROUP MAP PROCE[[LO SY
SU I LDINOS LQ/yTSK PGCONTRACTOR0ADDRESt ye,r T zC CTION DATA
CITr II TELNO ` N i. DEPTH
REGISTRATION NO (p J '/ COUNLE REPLR[XC! / ' L^G LOWER
NO I DESCRIPTION OF WORK FE[ TYPE OP CONNECTION v/ "MGT"FROM
HOUSE SEWER CONNECTING TO Y CURS P L M L TO P L
PUBLIC SEWER ® 6500 P C NO d
S RIC TANK SEEPAGE PIT OR CO IMP NO JOS NO a Q Q
PITS AND/OR D RAINFIELD ® SI000
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM C E300 �.
CONN ECT ADDITIONAL SLDO OR AFFIDAVIT I WAIVER I EAEEREXT RECORD INSTR NO DATE O
WORK TO HOUSE SEWER * 33 GO r
OVERFLOW SEEPAGE PIT DRAINFI[LD I(YJ
LETN CESSPOOL DRYW&LL MANHOLE* SS OO HWY OR ST WIDENING
ALTER REPAIR ORA A DON HOU51K
SEWER OR
DISPOSALSYSTEM * S3 Go STATE ENCROACHMENT ^
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMTf s z o0
AUTHORIZATION TOTAL FEF 4
CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED LZISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF IB_
OWNER OR NEW HOUSE SEWER
OWNERS ADEN T
CONNECT ADDITIONAL
ADDRESS BUILDING ORR WORK
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ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK BEEP PIT($)
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY ANO/OR GRAINFIELD
WITHALL COUNTY ORD INANCKS AND STATE LAWS REGULATING
FLU MS IND AND SEW E. CESSPOOL ❑ ORYWLLL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND /
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER 6n
SIO,AP.RMITTE. ' SACKFILL SEPTIC TANKS ❑
SCEP PIT(S) ❑ CESSPOOLS
OVALWATION ROBERT A WOOD
cK M D CASH SUPERVISING MECHANICAL ENGINEER
�7 3 2 9% FEB27 1 O D 5.0 Q— a
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