HomeMy Public PortalAbout5346 TEMPLE CITY BLVD_Sewer__ ""°"' APPLICATION FOR PERMIT' •
11-52
COUNTY OF LOS ANGELES SEWER- SEWAGE .DISPOSAL '
DEPAHTMENI'OF COUNSY`ENGDD:EB - - -
4 MU.MG AND SAFELY DMS[OIi eu1LolMa _ -
Cw))OffiF L LAI® . Cemtf �... ADDRESS �• . ^'
TT D G1D3FIIf. B�t d -udma LOCALITr
FOR APPLICANT TO FELL IN a osssmsr- -
LEGAL
_ DESCRIPTION LOT NO OWNER
BLOCK TRACT ADDRESS I MAIL '11')Tj 37 -77
I NO OF 1
ZE OF LOT NOW ON LOT ITY - E NO
USE OF t
BUILDING 1 DISTRICT x0 GROUP YAP
• BE PO
CONTRACTOR
ADDRESS lf=fo4o COMEC'AON DASA _
CITE TEL NO t siTATIOMS DEPTH
REGISTRATION NO B COUNTY MANHOLE REFERENCESTAIE UPPER
NO DESCRIPTION 0 K F
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $310
SEPTIC TANK SEEPAGE PIT OR I TYPE OF CONNECTION LENGTH FROM
PITS AND/OR DRAINFIELD 0 $3 00 T CURB IIIL TO P L
OVERFLOW SEEPAGE PIT ORAINFIELD
EXTN CESSPOOL ORYWELL MANHOLE 2 00
HOUSE SEWER CONNECTING TO p C pp
PRIVATE DISPOSAL SYSTEM 100 CO IMP NO TOB NO
CONNECT ADDITIONAL BLDG OR
WORK TO HOUSE SEWER 0 1111 00 TRUNK PERMIT NO ROAD PERMIT NO
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM 1 00 SPATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
����AT�p CHARGES
OYYAmis PEBMIZ 1 00 CONNECTION CHARGE FEE
AUTHOF=TION I TOTAL'FEE' -- - - -SU
REIMBURSEMENT FEE
I HAVE AT MED CON
TRACTOR TO CION NECT THE ABOVE DESCRIBES DATE A-CONTRACT WITH EXEXISTING HEREIN "DWELLING APPROVAIS DATE SPECTOR 931GNATURE
TO THE PUBLIC SEWER_ _ ___ - _ _ _ -, _
SIGNED TR )9 CNEWON HOUSE SEWER'
OWNER OR - CONNECT ADDITIONAL--"'
OWNERS AGE22�
BUILDING OR WORK
SEPTIC TANK.SEEP.PITS)-- - - - ---
ADDR - '"- -"- - - -- " ' _ -r AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION +-J--at
IN
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL Q- - - -'
WITH-ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS ALTER REPAIR SEWEROR
I-HEREBY CERTIFY THAT I AN PROPERLY-REGISTERED'AND/OR- SEWAGE DISPOSAL SYSTEM - --
LICENSED S RE UIRED By
LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
.ALIFOR O_R"iQ X'AT I AY THE LEGAL 0 NER OF T)JE ABOV ABANDON HOUSE SEWER
DESC�R�1yr nT1AL PROPERTY BACKFILL SEPTIC TANKS❑
SIONA v /AA SEEP PIT(S) CESSPOOLS
OFP `_`
ROBERT A WOOD - -
u a 0 x GUPERVISING MECHANICAL]ENGINEER -�--
_ . _ 401ON AL 19i - e _ __ 5.50
P.-eH