HomeMy Public PortalAbout5522TEMPLE CITY BLVD_Sewer I
�+APPLICATION ERMIT- J�F- S
COUNTY OF LOS ANGELES SEWER-SEWAGE DIS SAL 1'
DEPARTAIENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHNJL County Enginsam ADDRESS
T.AARTn
CASRATT V. GR17PQT. SRP't of Bon dlet LOCALITY G'(
NEAREST
R IN CROSS ST
LEGAL
DESCRIPTI L NO OWNER
MAIL
BI OCR ,yTRACT �[ L� RAI ADDRESS
OBS
an OF LAT , 6 /.f NO OF BLOT
NON ON LOT ITY TEL NO
USE OF
BUILDINGS �� `~'� DISTRICT NO GROUP YAP P C
CONTRACTOR
-1BE PG
ADDRESS ?. �� E 5 T CONNECTION DATA
CITY TEL NO B &0#&.Ve ION It* DWT.
STATH NA NO
CE PER
REGISTRATION NO O COUNTT
No I DESCRIPTION EOF WOR FEE
PUB ICS3��L'EWERCOEQNNECEETING TO S .a�1 I
PITS AND/OR DRAINFlELDIT OR 900 V V TYPE OF CONNECTION LENGTH FROM
T CURB PL Y L TOP L
OVERFLOW SEEPAGE PIT DRAINFIELD
ERTN CESSPOOL DRYWELL MANHOLE 9 $2 00
HOUSE SEVER CONNECTING TO P C NO
PRIVATE D13POSAL SYSTEM 1 00 CO IMP NO JDB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERt1T NO
WORK TOpp ROUSE SEWER pppp 1 DO
BSER OR D19M7AL DTSTEY HOUSE 1 OO STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PEBMIT 3 2 00 CONNECTION CHARGE FEE
AUTSOHI moN TOTAL PEE (fid ROMBURSEMENT FIX O O Loss-
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON AMOVA= DATE INSPECTOR$SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS DAY 0 Ig_ NEW HOUSE SEWER
OWNER OR M CONNECT ADDITIONAL
OWNERS AGENT/ BUILDING OR WORK
ADDRF�° SETCTANK BEEP PITS)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REOISTEREO AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BT LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT AL ROPERTY. BACKFILL SEPTIC TANKS❑
SLONATURE 8 PITS POO
OF PERYI
®r VAM TIO ROBERT A WOOD
CK ■ f GASR I SUPERVISING MECHANICAL ENGINKER
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