HomeMy Public PortalAbout5466 TEMPLE CITY BLVD_Sewer__ CTeweAEBOS3so e! APPLICATION OR PERMIT {�
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONV�TY
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uTYR8ETFOR APPLICANT TO FILL D i3° °*Ap¢ECRIPT ION LOT NO !/JRLO I Tll 9 RACT /\ glf9DO\ N /EIZB OF LOT NOW O OT 1/BUI 01RICT NO OROU■ MAP PROCCE➢ED RY
BUILDINGSEK PGCONTRACTORO -JADORE CONNECTION DATA
CITY TEL NoION DEPTH REGISTRATION NOHOL[RIIERENCE
NO DESCRIPTION OF WORK IEETYPE OF CONNECTION LENGTH FROMHOUSE SEWER CONNECTING TO CURE ML TO P L
PUELICS[WER • $S GO
SEPTIC TANK °[¢PAGE PIT OR _
PITS ANO/OR GRAINFIELD f1000 CO IM" NO p[�� JOE HO
HOUSE SEWER CONN ECTINO TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM $300
CONNECT ADDITIONAL SLOG OR AFFIDAVIT I RAITI•I [.V.RYNT RECORD IN HO DATE
WORK TO HOUSE SEWER 0 f300
OVERFLOW SEEPAGE PIT GRAINFIELD
EETN CESSPOOL DRYW¢LL MANHOLE O 3300
ALTER "[PAIR ORA HOUSE HV
VY OR ST WIDENING
SEWER
OR DISPOSAL SYSTEM C saw STATE ENCROACHMENT
PERMIT NO
INOUETRIAL
WASTE APPROVAL
OwNEKS PERMIT s s 00
CONNECTION CHARGE PES
AUTHOAIZATION TOTAL FEE
1 HAVE AT THIS OAT! A CONTRACT WITH THE HEREIN COM RIIMEU flSEMEXT IC�E)�.TRACTOR TO CONN CT THC AEOV[ O[BCRILLINg �PROV!\!7TO THE PUBLICE Eq OATS INSPECTOR E EIO TU E
SIGNED THIS DAY OPIBOWNER Oq NEW HOUSE SEWS"OWNERS AGENT CONNECT ADDITIONAL
ADORIB BUILDING OR WORK
HEREBY ACKNOWLEDGE THAT I HAVE ATION I.
BNO/OR GRAANK EFIE PITS)
NO/OR pRAINFIELO
AND STATE THAT THE A[OVE IS CORRECT OMPLY
WITH ALL COUNTY ORDqNANCES AND STATE L IIGULATING
PLUM EIMO AND S CESSPOOL ElORYWELL ❑
I HERESY CC HAT 1 AM Y R[OIR¢RED AND/O ALTER REPAIR BIWEROR
LICENSED Al R R[D
BY
LO
AN
OUNTY ND STAT[ SEWAGE DISPOSAL SYSTEM
CALF FOR IA O AT I AM THE LEGAL W ER O INT[ O DIBCOHN[CT PLUG AND
RCSIOE 1 E A OVE DESCgI ED IO TIA EgTY AEAryGON HOUSE 3[WHR
EIGNA [ BACKFILL SEPTIC TANKS ,
P[ SEEP PITIB/ ❑ CEESPO❑OL! `
ROBE T A I D
CK y G SUPERVISING MECHANICAL ENGINEER
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