HomeMy Public PortalAbout4836 TEMPLE CITY BLVD_Sewer__ QBD.S.SD APPLICAe kiPERMIT
COUP= OF Loa ANGMn SEWER—SEWAGE DISPOSAL 1
DEPARTN= OF COUNTY ENCK NMM
BUILDING AND SAFE!! DMSION BUILDING
IOHN A. LRIMBIS Corny Eng�e ADDRESS
CABBAY!A GBUPBT.Sup'1 of DuadmW LOCALITY
NEA
FOR APPLICANT TO FILL IN cpossREST Sr u- q
LEGAL
DESCRIPTION LOT NO w OWNER fD El
BLOCK TRACT MAIL
ADDRES
0 OF BLDG$ 11
SIZE OF LOTJfthvNOW ON LOT ITV TEL
USE OF
BUILDINGS DISTRICT NO I GROUP I DAP PROCESSED BY
CONTRACTOR PO
ADDRESS ,�� CONNEC'IION DATA
CITY TEL NO STATION DEPTH -
REGISTRATION N ATE
COUNTY MANHOLE F C6 UPPER
NO UDESCRIPTIO E LOW
PUBLIC SEWER CONNECTING TO EWER a '00
ggEEPTIC TAANK 4EEPAGE PIT OR TYPE OF CONN ION LENGTH FRO T
PIT9 AN D/OR DRAINFIELD Soo T CURB P L Y L TO P L d
OVERFLOW SEEPAGE PIT DRAINFIELD ♦`Iw /
EXTN CESSPOOL ORYN�LL MANHOLE 0 #2 00 A1
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO V
CONNECT
ADDIT[DNAYL BLDG OR 1
WEII GHOUSE 00
TRUNK PERMIT NO R NIT NO r
AL % p.a2 NEA HOUSE STATE ENCROACHMENT
1 r T
EPERMIT NO 3r1
INDUSTRIAL
WASTE APPRO A r
CHARGES
OWNER'S PEn= s Y 00 CONNECTION CHARGE FEE /
ADTHOB=TION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE I PECTOR S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS DAY OF Ig_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP, PIT(S)
SDDRFaa AMD/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE To COMPLY CESSPOOL El ORTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OB
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEW
I HEREBY CERTIFY THAT 1 AS PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RE91 TIAL PRO BACKFILLSEPTIC TANKS❑
DESCRIBED SEEP PIT 3 CESSPOOL!1711
OF PERWI
mP VAIMATj ROBERT A WOOD
} DL D.0. CYD SUPERVISING NDG MLOAL DNGINYDR
LAP 4009 JUL 251 0 o 300 a