Loading...
HomeMy Public PortalAbout5954, 5956, 5958 TEMPLE CITY BLVD_Sewer__ 16A'E42L-CE808 8-7,76 APPLICATION FOR PERMIT SEWER—SEWAGE DISPOSAL FOR APPLICANT TO FILL IN DISTRICT NO. GROUP BK MAP /// ZCgESSE11Y BUILDING 3 ADDRESS 5954 N. 1YY�}JJ City v ll` ✓ / / LOCALITY _Tem ler C i ty CONNECTION DATA NEAREST STATION Gr+��� 6, DEPTH CROSS ST. Woodruff y1�$/�*' - MANHOLE REFERENCE /r - UPPER OWNER Bill 1�Imick -.._..--_-. j TYPE OF CONNECTION LENGTH FROM MAIL �'�T �y.yr�+�y�}� Ave. CURB P.L. M.L.TO P.L. ADDRESS 10-3-33 j„�,g yy,Ea n 11 491 7 }. s.e �]•� CO.IMP. NO. 3 POB NO. CITY Whittier TEL, NO. 691 041 GAL TRUNK PERMIT NO. ROAD PERMIT NO. DESCRIPTION LOT NO_ AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE BLOCK TRACT NO. OF BIL DGS. ----- -- SIZE OF LOT NOW ON LOT _ H USE OF _O f✓w 4...'---''!/ "•' , BUILDINGS S4'Yt- MENT CONTRACTOR_-_ Square Deal_ Sewer Se •iee IN-jInM-RIA AL ,y lcl. I'� ate.` Q ADDRESS 67.-11 iy'1�}v..�son-SY �������tt_IJ}} -- �j _- _ [� CHARGES ��I V CITY EZ MOAte TEL. NO.T'TT'�2020 CONNECTION CHARGE FEE RA1� y{4 REIMBURSEMENT FEE O LTCENSF NO. 1288(0 --GLASS C-42 ---'------• NO. DESCRIPTION OF WORK FEELU APPROVALS DATE INSPECTOR'S SIGNATUgE HOUSE SEWER CONNECTING TO •�1 (�PUBLIC SEWER S i 4/0 -- - a SEPTIC fANK.SEEPAGE PIT OR NEW HOUSE SEWER PITS AND/OR DRAINFIELD _ � CONNECT ADDITIONAL �.. HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM - @ SEPTIC TANK.SEEP.PITS) CONNECT ADDITIONAL BLDG.OR AND/OR DRAINFIELD WORK TO HOUSE SEWER @ - OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.ORYWELL,MANHOLE CESSPOOL El DRYW ELL ALTER.REPAIR OR ABANDON HOUSE ALTER.REPAIR.SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON MOUSE SEWER BACKFILL SEPTIC TANKS ❑ OWNER'S Issuance Fee SEEP.PITIS) ❑ CESSPOOLS ❑ 5 Q AUTHORIZATION TOTAL FEE Z V ©0 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING PLUMBING AND SEWERS. TO THE PUBLIC SEWER. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SIGNED THIS DAY OF_ 19_ LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF CA'IFORNIA OR THAT I AM THE LEGAL OWNE OF. AND INTEND TO OWNER OR RESDE IN. THE ABOVE DFFFC�HID RESIDEN IAL OPER?Y, OWNERS AGENT SIG NUATRE K ADDRESS._ OF PERMITTEE A^" VALIDATION CK. M.O. CASH `O! Mha (� "Y)+ ? Z r (:H