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HomeMy Public PortalAbout5537TEMPLE CITY BLVD_Sewer z TEKPLE CITY ` AIM2p' Ttw 06 10 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION F G]]OHN A LUTDE CG®ty EBpue. SWQ.LIAM A. IEpB@f BIIP t d D utuldmQY Temple CityT Olive FOA APPLICANT TO FILL IN 9TDLOT NO 1 BLOCK TRACT 1 $06 S NO OF BLDGS BIZ! OF LOT NOW ON LOT CITY TEL NO UBC OF BUILDING/ •Lf DIHTRICTNO GROUP YAP PnOC[pp BY K PD CONTRACTOR Square Deal Sewer Service �p 3k ADDRESSqXnnn c C NNECTION DATA CITY El a TEL NO _ O STATION DEPTH STAT[ UPPER REGISTRATION NO COUNTY LH q[F[RFNCE LOWCfl NO CESCRIPTION OF WOR 1E[ TYreO ONNCCTI � LENGTH FROM 1 XOU/L8M'[R CONNECTING TO L _ /Y . PUBLIC SEWER O t80O - `N J( -, SEPTIC TAM SCCPAOi PIT OR P PITS AND/OR DRAINFICLD 0 11000 CO IMP HOUBC/EWER CONNECTING TO TRUNK PL 1 O T N O PRIVATE DISPOSALS STEM t8W I� 1 CONNECT ADDITIONAL BLDG OR oo AFFIDAVIT YY[t u[[rtR RECORD ING N AT[ L1L] WORK TO HOUSE SEWER 0 E300zr OVERFLOW SEEPAGE PIT GRAINFIELD In CKTN C99SPOOL DRYWELL MANHOLE 0 $900 - HWY ORST WIDENING z ALTER REPAIR OR ABANDON HOUSE SEWER ON DISPOSAL SYSTEM 0 63M STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL O C CHARGES J I PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE P[C I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FE! TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SSWERDAT[ INSPECTOR S SIGNATURE SIGNED THIS DAY OF IQ_ OWNER OR NSW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK StFTI 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR BEEP PIT(6) OR GRAINFIELDANO STAT! THAT THE ABOVE 18 CORRECT AND RGREE TO COMPLY XD/ WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWCLL ❑ I HEREBY E CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SWER OR LICENSED AS R80UIR[D BY LOS ANGLES COUNTY AND STAT[ OF SEWAO[DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED REBID[NTIA ROF Y ABANDON HOUSE BIW[R SIGNATURE r ,J OF PERMITTEE BACKFILL Srt EIC TANKS ❑ SlLP PIT(a) ❑ CESSPOOLS / {ALROBERT A WOOD CK M Y 0 O CASH SUPERVISING MECHANICAL ENGINEER LAfa9 6 8 33 LAA/ 4 1 0 0 5.00- 9