HomeMy Public PortalAbout5318TEMPLE CITY BLVD_Sewer cgs of 12{{ l ,
TSA 0/2D AP LIGATION OR PERMIT
COUNTY Of LO ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF CO NTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADOREBB
COLEMAN W JENKINS SUPT OF BUILDING
LocALITY ,E � c�0.
n(ARtsr
F
OR APPLICANT TO FILL IN `"°'P
LEGAL
PTION LOT NO y OWNER
MAIL
TMCT / 0 B
�10 OF BLDG{
SIZE Lm Now ON Lor CI MO
DISTRICT NO GROUF SIX MAR PROC(PS(D W
GS �
CTOR s�
�' STATION DEPTH
RLIC I UMERC NO CLA{t LOW"
DESCRIPTION O ORK FE( [ c ION L"DTH FROM
OU{C{EWER CONNECTI NO TO Y CURB P MLTOPL
BLIC OMER O (pOO EPTIC TANK -PAGE PIT OR / Jo NO
ITS AHD�OR ORAINFIELD O EI000 COIMP MO JOp NO
OU{C SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NOyIVATE DISPOSAL SYSTEM 0 E100 O
CONNECT ADDITIONAL SLOG OR AFFIDAVIT RYT[• [[t[P[E. RECORD INSTR NO DATE U
WORKTO H OU{CS(WER a EEOo
OVERFLOW SEEPAGE PIT GRAINFIELDCD
EXTN CESSPOOL ORYWELL MANHOLE O {S 00
ALTER R PAIR ORABANDOn-HOUSE HWY OR ST WIDENING W
6CWER OR DI{PO➢Al{YPTEMO )00 STATE ENCROACHMENT
PERMIT NO N
INDUSTRIAL
WASTE APPROVAL
OWNER'S PEAMR E 2 00 CHARGE{
AUTHORIZATION TOTAL PEP CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AHED CON REIMBURSEMENT FES
TRACTOR T4 CONNECT THE ABOVE D[BCJP"o E APPROVALS
TO THE PUBLIC SCW[R S 1 / DAT[ IN ORS{ NATURE
SIGNED THIS D OF E IG Z
OWNEROR NEW HOU{[SEWER
OWNERS AOENT_
CONNECT ADDITIONAL
WORK
ADDRESS
BUILDING OR WORK
SEPTIC TANK BEEF PIT(S)
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIio
N ANO/OR DAAINFIELD
AND STAT( THAT THE ABOVE 19 CORRECT AND AGRY
WITH ALL COUNTY ORDINANCES AND STATE LAWG ❑ DRYWELL ❑
PLUMBING AND SEWERS CESSPOOL
1 HEREBY CERTIFY THAT 1 AM LY REGISAND/OR ALTER REPAIR S[WCROR
LICENSED R[OU EO BY LO ANO S C OF, SEWAGE DISPOSAL SYSTEM
GLIfOR OR OW F A
REBID TH6 OVE DCS Ip ( 1 AL RDISCONNECT PLUO AND
ABANDON HOUSE OMER
BI
F PE RT(( CKFILL SEPTIC TANKS ❑
[[P PITIS) ❑ CESSPOOLA
A N JACK R ALLEN
o CASH SUPERVISING MECHANICAL ENGINEER
(R�I s o 2% SU12 1 0 0 7.00-