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HomeMy Public PortalAbout5808 TEMPLE CITY BLVD_Sewer__ '$ 04.8 :xAPPLICATION FOR PERMIT .808 -8=86 COUNTY OF LOS ANGELES SEWER—SEWAGE D I S POSA L DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDINGS JOHN A. I.AMBIE, Count ADDRESS � 08-1 1e am City B w CANATT D. GRIFFIN,Supl of Building LOCALITY €� rt'� CROSS Slit) FOR �PLIC;F�NT T�7 F'II.I. IN _ ;..�.�. D ESCRIPTION LOTNU .> =R: o�vrlBR kl ` " MAIL - c � ;,� m ADDRESS 1i'1 °� TSI. .. NOWON LOT CITY G TEL.NO. 2Rep, - DjISTRICT CdA. GROUP MAP PR�9CESSED BY - I Bid P6 CANTRACTOII,Sauar Deal Sewer Se `vice �� „t ADDRESS 3 axson d. _ CONNECTION D1 A CITf,,iE1 Mo hh e TEL.NO..G 14-2020 STATION 7 ISI :. w x DEPTH 1�, REGISTRATION NO. STATE mMANHOLE REFERENCE '- UPPER. u COUNTYZ ' 4dd r LAWER ,, NO. I DESCRIPTION OF WORK FEE �p*qq "HOUSE SEWER CONNECTING TO �C� PUBLIC SFW:R @ $3.00 trYPE OF CONNECTIO LENGTH FROM SEPTIC TANK,K,SEEPAG.�E,yPIT OR PITS ANO/OR Y. CURB F Lam-' M.L.TO P.L. J° �...- 7?.Atfv,_.,-D C. $3,00 _ OVERFLOW SEEPAGE PIT,DRAINFIEC,D EXTN.,CESSPOOL.DRYWELL,AIAhHOLE $2.00 HOUSE SEWER CONNECTING TO � P.C.NO. PRIVATE DISPOSAL SYSTEM $1.00 CO.IMF.NO, l &'"-' moo, JOB NO. 50YOR E Q CT I�0�SEISEN R BLDG.OR $1,00 1 00 TRUNK PERMIT NO, ROAD PERMIT NO. ALTER, REPAIR OR ABANDON HOUSE STATE FNCROACHMEIdT SEWER OR DISPOSAL SY'STEhI $1.00 _PERMIT N0. INDUSTRIAL WASTE APPROVAL ��7 - - CHARGES " OWNEWS PERMIT s 2 BO CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE r REIMBURSEMENT t:EE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPRC DATE I":YSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, SIGNED THIS—DAY OF I9— -NEW HOUSE SEtv>AR OWNER OR CONN IN ADD➢ ORK OWNERS AGk,IdT�...� m.,. L'UILDING OR WORK SEPTIC TANK,SEEP,PITS) ADDRESS — AND/OR _ DRAINFIE.LD I HFFREPY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _ �AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DP?VELL_ WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR - PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -SEWAGE PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF rISCONid HOUSE AND CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF THE ABOVE EWER DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKSSIGNATURE [J SEEP.PITS) L7 CESSPOOLS OF PERMITTEE Ij VAIIDATION ROBERT A.WOOD CPQ, M.0. CASH SUPERVISING MECHANICAL ENGINEER (5 . ..