HomeMy Public PortalAbout5718 TEMPLE CITY BLVD_Sewer__ 2"50 VaBITS
76"410°° APPLICATION POR PER IT :- .�
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL Z
DEPARTMENT OF COUNTY ENGIlIEES
BUILDING AND SAFETY DIVISION BUILDING IE 19
ADDRESS
_ IWIfY6BE�A. . BuP7 m nml LOCALITT '
NEAREST
FOR APPUCAM TO FU IN CROSS
LEGAL
DESCRIPTION LOT NO AIR'
BLOCK TRACT MAIL
ADDRESS
NO OF RLDG
SIZE OF LOT NOW ON LOT CI
USE I DISTRICT NO UP MAP RO
DUI
LDIN69
CONTRACTOR
I
V
ADDRESS CONNR DAiA
CITY 0 STATION DEPTH
STATE MANHOLE RE ERENCE P
REGISTRATION N COUNTY
NQ I
1111 DESCRIPTION OF WO FEE
PUBLICSSEWERRCONNECTING TO 1p S 00
SEPTIC TAEENWWKEE SEEPAGE PIT OR T TYPE OF CURS ECT P L LENGTHPPROY
PITS AND/OR DRAINFIELD _
OVERFLOW SEEPAGE PIT DRAINFIELD
N 9 DRYNEA 00
OUSE SEWER CONNECTI„6 9 IIA go
TO P C NO
/, C g 1 CO IMP NO JOB NO
MONK TO XOUSEIS NAL BLDG ORX1,00 TRUNK PERMIT NO ROAD PERMIT NO p I
ALTER o EPAIR ORE1A1'BEAANDON ROUSE i STATE ENCROACHMENT CppppppJ
DISPERMIT NO
INDUSTRIAL
_ WASTE APPROVAL
CHARGES
OWNER'S PERMIT CONNECTION CHARGE FEE
ATIMORMTION f TOTAL FEM REIMBURSEMENT FEI HAVE AT E
TGCTOR TO CIS DATE A CONTRACT IONNECT THE ABOVE DESWITCRIBXL EXISTING REIN ADWELLMED /NG APPROVALS (/DATE ( IM SPECTOR 8 SIGNATURE
TO THE PUBLIC SEVER
SIGNED THI AY 8 MEA HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGE— BUILDING OR WORK
ADDHE SEPTIC TANK SEEP PIT(S)
AXO/OR DRAINFIELD
1 HEREBY ALKNOWLEDG! XAT 1 HAVE GD TN19 A LILATIO
AND STATE THAT THE AB E IS CORRECT AND AGREE 0 COMP CESSPOOL DRYWELL '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEVER OH
PLUMBING AND SEWERS ALTER
REPAIR
DISPOSEWER
AL R
1 HEREBY CERTIFY THAT I AN PROPERLT REGISTERED AMD R
LICENSED AS REQUIRED BY LOS ANGELES COU D 333TTTAT F DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 HE LEGAL ER OF TIL[ E ABANDON HOUSE SEVER
DESCRIBED RESIDEHTIA R RTY / BACKFILLSE TANKS -611,
SIGNATURE SEEP IT ! IC CESSPOOLS Z'O
OF PERMITTE
mF VALIDATION ROBERT A WOOD _
� R ° ."� SUPERVISING MECHANIC-IJ. YN61N6E1t
LAC01957�- M 21 OD 500 �°