HomeMy Public PortalAbout4349 TEMPLE CITY BLVD_Sewer__ CBe0eAPPLICATION FOR PERMIT
CE BLEDD
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGDa=
BUELDING AND SACFeuE�TeY. DrVIMON BUI ADD
Eforwmw_ Louun
NREST
FOR APPIMANT TO CiD
LEGAL
DESCRIPTION LOT NO 01fHER
BLOCK TRACT R MAIL r
r ADDRESS
MO OF BLDG!
SIZE OF LOT now ON LOT 1
USE OF
BUILDINGS DISTRICT NO GROUP MAP By
It ro
CONTRACTOR
ADDS J' CONNECTION DATA
C T[L No (J
STATION
DEPTH
IIE6ISTR11T10M NO O� �+� COY MANHOLE REP RUPPER
LOWER
NO II USECS NIR CONNECTING TO SES W d
SU6L� TYPE OF COMM CTION LEMGT FROM
SEPTIC TANK lEEPAIE PIT OR T CU P ■L PL
PITS AND/OR ORAINFIELD !
OVERFLOW SEEPA,D IWRAINFIELD
OUSE SE01 W C7IONNNECTI G TO I CO IMP NO JOB 0 OV
WORK TO XOU�E IEWEIIBLDG OR '00 TRUNK P[R NO \ ROAD PERMIT NO O
I"J�=ABAON HOUSE !I !TATE CROACHMENTGO I-
PERYI 0 lam!
IN STRIAL
WOMAPPROVAL
e I
OWN WS PEHMIS 00 CONNECTION CHARGE FEE
AUTHORIUMON TOTAL FEE o RKIMBURSEIIENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESC[IBED ]EXISTING DWELLING APPEOV DATE INSPECTOR S SIGNATUR[
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF IB_ NEW MOUSE SEWER
OWNER OR CONNECT ADDITIONAL /
OWNERS AGENT BUILDING ON WORK
ADDRESS T
ANO/ORDRK SEPITIS)
ELO !
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I
AND STATR THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWEL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWER OR
I HEREBY CERTIFY THAT 1 AN PROPERLT REGISTERED AMD/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LO! ANGELES COUNTY AND STATE OF DISCONNECT PLUS AND
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI PRO BACKFILL 6E CTANKS
SIGNATURE SEEP PIT D CESSPOOLS
OFPERMIIIEE
VALIDATIOW1—'1 ROBERT A WOOD
CC ■ 0 CMY SUPERVISING M[CHANICAL MNGHKIUM
�i'. 2 0 9 3 Ql ;IAM 3 1 0 D 5.00