Loading...
HomeMy Public PortalAbout5247TEMPLE CITY BLVD_Sewer OA64ZOG-" APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bu1LDIHG y7 WMALAMBIE Cauaty Eamew AD DREBe A IERSM, Sup I d Bwldm7 Z LOCALITY� ,r NfAR¢ST FOR P LEdAL CANT TO FML IN c9oaa aT f MA I DESCRIPTION LOT NO �'y� OWNER ) ` / BLOCK TRACT '� I� _IV CJ ADDREaf z` SITE OF LT /W Y� NOW OM NO f LOT CITY TEL NO 0 �O USE OF J DISTRICTNO GROUP MAP PROCESSED BY BUILDINGS T Q CONTRACTOR J. R W obe-r -IVC S.Oa T BN PO ADDRESS CONNECTION DATA CITY `rl TEL 'L RATION DEPTH A(pSTAT[ UPPER REGISTRATION NO COUNTY MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FE[ TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TO P L Y PUBLIC SEWER O !a 00 Q. SEPTIC TANK SEEPAGE PIT ON P C NO O JOa NO PITS ANO/OR GRAINFIELD t C slow CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT MO ROAD PERMIT NO DI "S PRIVATE DISPOSAL"STEM C !300 K CONNECT ADDITIONAL BLDG OR AFFIDAVIT I oM[t I unw.T RECORD INS" NO DATE O WORK TO H OUS¢SEWER 9300 {LLrJI OVERFLOW SEEPAGE PIT GRAINFIELD E%TN CESSPOOL ORYW[LL MANHOLE O la 00 y AMMPREMMFBR ASAMO NWY ORST WIDENING yJ d�fW DISPOSAL SYSTEM O 930016"00 STAT[ENCROACHMENT Z PERMIT NO INDUSTRIAL ''EBT�p�QQIN Tt APPROVAL O..NEWS PERMIT $ CHANG" AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEC I HAV[ AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT ME TRACTOR TO CONNacY THE ABOVE OtfCRIB[D [%16TIN0 DWELLING -n *� TO THE PUBLIC SOWER " OVALS DATE INSPECTOR 9 SIGNATURE SIGNED THIS DAY OP OWNER OR NEW HOUSE SEWER OWMERp ADEM CORN ECT ADDITIONAL ADDRESS BUILDING ON WORK B66P ITY) IDXSHAT I HAVE RAD 1ECAOM AND/OR GRAINFIELD ANYTATE THAT THE ABO ICORRECT AND AGR[ TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATIHO PW MSING AND SEWERS CESSPOOL ❑ ORYW LLL ❑ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORM IA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IM THE ABO SC IGEN L P P[RTY ABANDON HOUSE SEWER fIGNATUR[ ❑ OF PERMITTE ACKFILL SEPTIC TANKS11i BEEP PIT(B) ❑ CISSPOOL VALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH Lhooi 0 2 ea AL 8 1 0 D 5A0- 9