HomeMy Public PortalAbout5460TEMPLE CITY BLVD_Sewer 74A 6420 -CE[D8-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 460 N. Temple City Blvd.
LOCALITY Temple Cit
Ll FOR:APPLICANT TO FILL IN N[ARE[T OliveCFO/p ST
O[DC.'PTION O 0✓ OWNER Richard Bowen
MAIL
BLOCK (II ADDRESS 1620 el
NO OF SLOGS
/IZE OF LOT NOW ON LOT CITY TEL NO
USE OF
pUILDINOp DISTRICT NO I GROUP I OK MAP /F//R/f/��CHp�EIO pY
CONTRACTOR S' e / � /PS 2.2-1777( [/fir L7
ADDRESS 2 `/J' CONNECnox arra ✓vd
CITY El Monte 9--L
J TEL No 444-2020 STATION DEPTH
ATK
Lic
LICK NSE No, 128870 CLASS C-42 MA NHOLC REFERENCE /4 No OT LOW[
NO I DESCRIPTION OF WORK F[[ TYPE OF CONNECTION✓ LEN
OTH FROM
ROUE[/[W[R CONN[CTINO TO Y CURB M L TO P L
PUBLIC SEWER 0 $7 00 7 00 / POO.
L MO
pE"IC LANK SEEPAGE PIT 011 CO IMP NO (� JOE NO
ITS AND/OR GRAINFIELD 0 slam
HOUSE/EWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d
PRIVATE DISPOSAL SYSTEM t600 O
CONNECT ADDITIONAL BLDG OR AFFIDAVIT g111S 1uu�R1 RECORD INS" NO DAT
WORK TO HOUSE SEWER 0 $S OO U
OVERFLOW SEEPAGE PIT ORAINFIELO
[ATN CESSPOOL ORYW[LL 5900 0
ALTER REPAIR OR ABANDON HOUSE HWY OR BT WIDENING 0
SEWER OR DISPOSAL SYSTEM 0 53W STAT[ENCROACHMENT
MANHOLE $7 00 PERMIT NO a
INDUSTRIAL W
I �� arc%CsG WASTE APPROVAL Z
O��tTATWS PERM S 3 00 CHARGED
ADTHOFMTION TOra1 PEE I HO CONNECTION CHANCE F[[
1 HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ArCtfOVA�
TO THE PUBLIC SEWER DATE INSPECTOR B SIGNATURE
SIGNED THIS DAY OF IR_
OWNER OR NEW HOUSE SEWER 1
l
OWNERS AGENT
CONNECT ADDITIONAL
wppR[/S BUILDING OR WORK
SEPTICTANK DEEP PIT(S)
1 HERESY ACK NOWLEDO[ THAT 1 HAVE RtAO THIS APPLICATION AND/OR GRAINFIELD
AND STATE THAT THE ABOVQ IS CORRECT AND ACRE[ TO COMPLY
WITH
COUNTY ORDINANCES AND STATE LAWS R[OUATINO
PLU MSING AND SEWERS CESSPOOL ❑ DRYW[LL ❑
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
CALIFORNIA OR THAT AM THE LEGAL OWNER F AND INTEND TO DISCO N N ECT PLUG AND
RESIDE IN TH! ABOVE D[BCRIBCD RtSID[NTI PROPERTY ABAMDOry HOUSE BSW[q
SIGNATURE
OF PERMRTCC BACKFILL SEPTIC TANKS ClfCEP PIT,• POOLS
VALIDATION cX M O CASH
O'9 9�I4AR '3 51
0 A 13.0 0 �`