HomeMy Public PortalAbout4846 TEMPLE CITY BLVD_Sewer__ �TaAG,i�-0E APPLICATION FOR PERM T
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPAATNlENS OF COUNTY ENGIIiEEB
BUILDING AND SAFETY D11MION BUILDING
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WOSIAM A IENSEN Sup E of budding
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FOR APPLICANT TO FILL IN
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D[eCRIPiION LOTNO OWNER Ex d f`
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BLOCK TRACT / ADDRESS
SIZE OF LOT I^• 7 ' NOW ON LOT2 if G- [-
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DISTRICT NO GROUP MAR PROCESSED BY
DNCOXTRACTOR ADORE" 1 CITY12 STEL XO ` I STATI DEPTH
E MANHOLE RURR[R
R[OISTRATION NO NTY LOWER
NO DESCRIPTION OF WO K FE[ TYPE OR CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB R L M L TO FL
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PUBLICEEWCR $5 Go
i[PFIC TANK SEEPAO[MT OR P O
PITS ANO/OR
ORA
[IO DO CO IMP NO JOB NO
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HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM Q SS OO OC
CONNECT ADDITIONAL BLDG OR AFFIDA IT RgYIIIutr...I RECORD INETR NO DAT[ O
WORK TO HOUSE SEWER O p OO 1{rul
OVERFLOW SEEPAGE PIT DRAINFIELO
C[TN CESSPOOL ORYW[LL MANHOLE O E5 00 p_
ALTER REPAIR OR ABANDON HOUR[ SirID[X p N
[EWER OR DISPOSAL SYSTEM Y $3 GO STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARD
OWNERS PERNQi f z 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F
TRACTOR TO CONNECT THE ABOVE DESCRIBED ")STING DWELLING � O�w*O
TO THE PUBLIC SEWER AM DATE INSPECTOR S SIGNATURE
SIGNED THIS D OF IS"
OWNER OR NEW HOUSE SEWER
OWN6RB AGENT CONNECT ADDITIONAL
AppR[66 /If S BUILDING OR WORK
1 H[R[BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION S6IIIC TAXK BEb PIT(6)
AMO/Ow DRAINFI[LD
AND STAT[ THATTHE ABOVE 1E CORRECT S AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[TE LAWS REGULATING
PLUM BIND AND SEWERS CESSPOOL ❑ DRYW[LL ❑
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOB ANOLt6 OUNTY AND STATE Of E[WAGE DISPOSAL SYSTEM
CALIFORNIA OR 1,;A. TN[ L ALINTEND TO DISCONNECT PLUO AND
RESIDE IN TH[ ESERTS RHS L P P[RTY ABANDON HOUSE SEWER
aIONATUREOPPERMITTEEBSEP PILL PITIS` ❑PTIC TANXS
ESSPOOLS
VALIDATION ROBERT A WOOD
cK M O CASH SUPERVISING MECHANICAL ENGINEER
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