HomeMy Public PortalAbout4805 TEMPLE CITY BLVD_Sewer__ DEPAILTMENT OF OOUNTY ENGM3= ' ' SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDINGS AND SAF= PERMIT APPLICATION
COUNTY OF LOS ANGELES BUIL
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HOUSE SEWER O�IIN'EU- NO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EX PTIO RECORDED
WORK TO HOUSE SEWER 100
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SEWER OR DISPOSAL SYSTEM IM
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I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ W HOUSE SEWER p
OWNER OR NNECT ADDITIONAL
OWNERS AGENT_ __ _ _ _ _ _ _ _ _ _ __ ILDING OR WORN =��-�/� /Q'%�� �
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I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REOISTEREDI D19COMMECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER I' L
ER OF THE ABOVE DESCRIBED TIAL PROPERTY I BEEP PILSSEPTIC
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