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HomeMy Public PortalAbout5330 TEMPLE CITY BLVD_Sewer__ APPLICATION FOR PERMIT f COUNTY OF LOS ANGELES SEWER.—SEWAGE DISPOSAL 1 DEPARTMENT OF C40UNTY ENGDNEER BUM)ING AND SAFETY DIVISION eulAD Loa�iso 3 IC L8 /v , JOHN JL Lal[BDK, Ceamtr sRgb� cassia D aRn7lu,sup•+of sundbag -LOCALm H NEAREST To s ST v D ESCRIPTION LOT n0 NxEa TRACT EAI"ADDRESSNO OF BLDGS LO J NON ON LOT TELNSENSES pa NGS 1� DISTRIRNOGROUP YAPCTOB (/{` � °� KS / c�/ CONNNE=ON DATA 7E TEL NO �p STATION d DEPTH RATIOX NO �J arATE MANtlOLE aEPER®ICR i/D SCRIPTI F WOR FEEOUSE SEMER CONNECTING TO PPU BLIC 9ENER S00 TYPE OF CONRECTIO LENGTH FAOY O EPTIC T/�NR SEEPAGE PIT OR T CUP LMLTOPLITO AXD/ORDRAINFIELO !00 VERFLOW SEEPAGEPT DRAINFIbL0EXTN CES! L DRTNELL MANHOLE Y 00HOUSE HEWER CONNECTING TO P C NO PRIVATE DISPOSAL SYLSTE■ 1 00 0 IMP NO JOB NOzp./�O�77R[[IKC TOpp HOUSE SEWERSLpDpG OR 1 00 TRUNK PERMIT NO ROAD PERMIT NO 16 p7�G95 OR DISPOR OSAL 374Tfi IS NOOSE 1 00 STATE[KYR ENCROACHMENT INDUSTRIAL WAST APPROYA CHARGES OWNER'S PETWT 00 CONNECTION CHARGE FEE AUMOIMTION TOTAL FEE p0 REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPHOVAIS DATE INSPECTOR S SIGNATURE TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEN6a SIGNED THI / v AY OF 19v— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT -BUILDING OR WORK ANKEp ADORNEI AND/ORTDRAI LO PITS) 1 HEREBY ACKNOWLEDGE THAT NAVE READ IS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 13 DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I TH HEREBY RT AT I AN PROMMLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSEDus IRED BY LOS ANGELES COUNTY AND n OF ABANDON HOUSE S B IDK IAL P EWER CALIFOR A OR T T I T OW ,% VE DESCRIBACKFILL SEPBC TANKS❑ SIOHATURE .. SEEP PIT(S) CFSSP00V OF PERYI Or VALIDATION ROBERTA WOOD u ■ a CYE YUPERVIYINa NRCHANICAL RNa1NERR i 1�'Lo l o.3 8M Ads 1=i 1 "o A 6 A 0 2