HomeMy Public PortalAbout5708 TEMPLE CITY BLVD_Sewer__ APPLICATION+FOR PERMI
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION AODRESBJU)D=NG! S T
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LEAL
DESCRION PTILOT NO O. , O Y • OiRER
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BLOCK F..TRACT 6PNO OF
W A DRESS O NO 'SIZE OF LOT i .l NOW ON LOTf
SIy CITY . to
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USE OF DISTRICT NO GROUP YAP PRO Bt
BUILDINGS
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CONTRACTOR15 i
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CONNECTION DATA
CITY TEL NO Aft ZWSTATIONZZE DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO COUNTY O
Ho UfDJESCRIPT 0 OF WOK FEE
HOWSE SEWER
EW ERCONNECTING TO 19 00 �� Ar
TYPE OF CONNECTID LENGTH FROM /
SEPTIC TANK SEEPAGE PIT OR T CURB L Y L TO P L
PITS AND OR DRAINFIELD B 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN
C SPOOL DRYWELL fz DO
HOUSE SEWER CONNECTING TO PO
C NO
PRIVATE DISPOSAL
I PO ApL STSTEM
00 CO IMP NO JOB NO p
CONN F�CTtOUSEIS EIYER�G OR 1 TRUNK PERMIT No ROAD PERMIT NO OR
WORK U
A TER R PA R OR BAHDON HOUSE 1$ DO STATE ENCRO CXYENT pl
PERMIT NO CpPprQJ7j
INDUSTRIAL
WASTE APPROVA
CHARGES
OWNERS PERMIT 2 00 CONNECTION CHARGE FEE
AOTHOBZATION I TOTAL FEE Q!j REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EKI ING DWELLIN APPROVALS DATE INSPECTOR!SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS AYQF-
HER
F 8 nEW xousEZ sEWER 05'AT 2
OW HER OR CONNECT ADDITIONA
OWNERS AGENT BUILDING OR WORK
ADDRESS. SEPTIC TANK SEEP IT(!)
AND/OR BRUMFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRTWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR -
PLUMBING AND SEVERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED By LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT ROP RTY BACKFILL SE C TANKS
SIGNATURE SEEP PITS CESSPOOLS
OF PERMITME
®T VALIDATION ROBERT A WOOD
CL ■ O CUB SUPERVISING M16CQiANICJLL BNOINHHR
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