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HomeMy Public PortalAbout5842-5844TEMPLE CITY BLVD_Sewer (2) A E808 10-63 6A 542 D APPLICATION FOR PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL Ll BUILDING AND SAFETY DIVISION 11U,11-DING A, JOIHN A. LAMBIE. County Engineer '.R'SS WILLIAM A. JENSEN, Supt of Building L,ICALiTY S '0 SS_ST C ------ FOR APPLICANT TO FILL IN RO • DESCRIPTION LOT NO OWNER ----------- LOCK -RACT T MAIL B ADDRESS I NO. OF BLDG S. SIZE OF LOT NOW ON LOT TEL. NO. BU'LD N "4,V, DISTRICT NO, GROUP MAP PROCESSED 5Y x BK PG CONTRACTOR P 10D ADDR _.lye .ESS s CONNECTION DATA 1 E L, N0.L% (ji !iN S T A r 101 N DEPTH STATE MANHOLE REFERENCE REGI-STRATTON NO.C_ COUNT OWER C_ FEE ]F�CRIPTIC)N - TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO CURB P.L. M.L,TO P.L. PUBLic SEWER P.C.NO� .5 CPT fC T 4 IN K-SF E_Fl A G EP TT 0 R PITS AND/OR DRAINNELD S10.00 CO IMP. NO. JOS NO. HOUSE SEWER CONNECTING_T6 PRIVATE DISPOSAL SYSTEM 3.00 TRUNK PERMIT NO, ROAD PERMIT NO. CONNECT ADDITIONAL BLDG CR $ --kVF- M T-M Re FI 6 7; ITER �FMEST ORD. (NSTR,NO. DATE WORK TO HOUSE SEWER @ $3,00 EXTN.,CES$FOOL,DRYWELL,MANHOLE @ $5.00, HWY.OR ST.WIDENING X6A_N_D­O_N HOUSE -TEEN— C_WMENT DISPOSAL SYSTEM @ 53 0o -ST lil-A A C � -1" -;-" I PPERMITNO. c f INDUSTRIAL WASTE APPROVAL Jj CHARGES OWNEWSPiRMIT 2] 00__ CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE A HAVE AT THIS DATE A C'ON'TRACT WiTH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRA CT R T CONNECT THE ABOVE DESCRIBED EXISTING DWELL?NG APFR_OV___ _T_.ATE IN.PECTOR'S SIGNATURE 0 0 — ' TO THE P LJBLiC SEWER, ALS SIGNED THIS-DAY -i• ----"-- OWNEROR NEW HOUSE SEWER OWNERS AGENT- CONNECT ADDITIONAL I. ADDRESS BUILDING OR WO T_ SEPTIC TANK SEEP,P(T(S) I HFRERY ACKNOWLIEO�,E THAT I HAVr. READ THIS APPLICATION ANO,OR GRAINFIELD 'I'L, S I HE AHDVCr AND AUREE FO COMPLY ,ATE THAT !� CORRECT Wj'H COUNTY COUNTORDINANCES AND STATE LAWS RFGULA*!ING P�LU M.8 ING AND SEWERS RS. CESSPOOLn "RYWEI_L D HERE BI' CERTIFY THAT I AM PROPERLY REGISTERED AND.'OR ALTER,RE'AIR,SEWER OR C.CEN'FO AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RF51r _)E IN, THE -_S.,kVE D—CRIBED RES!DEN U S 0 ABANDON HO E:SEWER BACKF ILL SEITIC TANKS StQNATURC OF FERMITTEF kJ VALIDATION ROBERT A. WOOD CK._� M.0. CASH SUPERVISING MECHANICAL ENGINEER LALO 7 2 1 7r. N10-11 9 5 0 5,0 Q-