HomeMy Public PortalAbout5537TEMPLE CITY BLVD_Sewer z TEKPLE CITY
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Ttw 06 10 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION
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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
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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
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