HomeMy Public PortalAbout4805TEMPLE CITY BLVD_Sewer 75AG4 D APPLICATION FOR PERMIT
CESOB D
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADD
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LEGAL
DESCRIPTION LOT No /.i OIFNE[ /JAS'' eEEZ d
BLOC[ TRACT MAIL
�W ADDRESS
NO OF SLUG[
SITE OF LOT NOW ON LOT CITY
USE OF
BUILDINGS DISTRICT N //ROUP NAF `� By
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CONTRACTOR G-RQ -OL (///I (?j � ! D / � _1M
ADDRESS/ L Y 3 7 Va/EF- W&/ f CONNECTION DATA
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ATE MANHOLE REFERENCE P
REGISTRATION NO YD Y�� C U WLR
NO 1111DE
l!EESCRI F FRI
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PUS4C fWNNECTING TO $300
;EPTIA TAN[ SEEPAGE PIT OR [ OF CON CTIOM LENGTH FROM
1T!AND/OR DRAT NFIELD T C P M L TO P
OVERFLOW SEEPAGEE PIT DRAI NFIELD
XOr SEWER CONNECTI GTO P C NO O
IpIA1 A X71 LNSY M CO IMP MO JOB NO u
CORK TO tODUD EWER�G ORa M.00 TRUNK PERMIT NO ROAD PERMIT NO Of
TERNEPA R ORABAN HOUSE STATE ENCROACHMENT O
En OR I1 PERMIT MO G
INDUSTRIAL O.
-WASTRAPPROVAL y
CHARGES
•TOWNEWS PEOUT 00 CONNECTION CHARGE FEE
AUTSOHmAnoN TOYAL FEE REIMBURSEMENT FEE
I NAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED IEISTINO DWELLING APPHO DAlk INSPECTOR BSI
TO THE PUBLIC BEWER.
SIGNED THIS DAY OP TB— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AO[NT BYILDIMG OR WOpK
ADD SEPTIC TAN[ BEEP PITH
AND/OR DRAIMFI[LD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THEA YE IS CORRECT AMD AGREE TO COMPLY CESSPOOL DRTW[L
WITH ALL COUNTY ORD ROES AND STATE LAWS REGULATIRG ALTER REPAIR SEWERON
PLUMBING AND SEWERD
I HEREBY CEIRIFi T 1 PROPERLY GISTERED AMO/OR SEWAGE DISPOSAL SYSTEM
LII HERE AS E IRE! er GELES HTT AND STAT[ OF DISCONNECT PLUG AND
CALIFORNIA OR T AM LEGAL HSR OF THE
ASOV[ A BANDON HOUSE SEWER
DESCRIBED RESIDE BAC[FILLSE CTAN" Ll
SIGNATURE SEEP PIT0) CESSPOOLS
OF PERMITTEIL__A 1y
/PE],IDATION ROBERT i WONOD
CASH DUP'PJIVIROB MRGHA WOENGIN®[
M5730-= 51 OD 3.00 9