HomeMy Public PortalAbout4351 TEMPLE CITY BLVD_Sewer__ CEDODAPPLICATION FOR PERMIT
CESOI DD
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPAHTbIENT OF COUNTY ENG21M
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SIZE OF LOT
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CONTRACTOR
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RE6IDTRATION RO COUNTY LOWER
NO I
HUU![C DESCRIPTION CONINECTIMa TO 00 TYPE OF CO NE ON LENGTH FROM L_
►SEPTIC T HK SCEP OE PR OR f B L 70 P L
PI TD AND/OR DRAINFIELD
OVERF SEEPAON PIT DRAINFIELD 1 -44,
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NO ER COXNE I GTO P C NO O
MIN Ap M1IS�II,, co o JOB No 1 V
IOIORII 0 HOU! OW11 LDG OR4 d @ 1100
TRUNK PFJi YIT NO ROA R MO O
A T8R I R OR ABANDON HOUSE STATE EXCROACNYEHT
SAL SYSTEM 4p d 00 PERMIT NO
IN
DWCHARGESMED C
OWNER'S PERMT 00 CNNECTION CHARGE FEE
AUMOEMnON TOTAL I= RKIYBURDEYENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE MED CON-
TRACTOR 70 CONNECT THE ABOVE DESCRIBED EZISTINHOADWELLINa APPHOV DATE INSPECTOR D SIGNATURE
TO THE PUBLIC SEWER. /
SIGNED THIS DAY B_ NEW HOUSE SEWER ,4
OWNER OR
ML
OWNER / !'
OWNERSAGENT BUILDING OR WORK
SEPVE
ADDR AND/ORTDRAI NF19LDANK SEEP flT(D)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL 13
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATNG ALTER REPAIR SEWKR OR
PLUMBING AND SEWERS SEWAGK DISPOSAL SYSTEM
I NEWEST CERT► T 1 AN PROPSRLT REGI AND/OR OIMONNECT PLUG AND
LICENSED AS R B7 LOS
ANGELES COU D STATE OF ABANDON HOUSE SEWER
CALIFORNIA 0 1 AM THH LE OWM THE ASOn
D83CRIBED R PROP[RTV BACKFILL SE C TANK!
CILIFORM6 0� SEEP PITS CESDP
OF PERYI
VALmROBERT A WOOD
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