HomeMy Public PortalAbout6052 TEMPLE CITY BLVD_Sewer__ 16AC42D
S E-663 It.55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
I
JOHN A. LAtABIE, COUNT Y EN L DDRESS
GHNEER A
CASSATT D. GRIFFIN, 13w"r cr BUILDING LOCALITY
FOR APPLICANT TO FILLNEARESTIN CROSS
LEGAL
DESCRIPTION LOT NO. OWNER
MAIL
BLOCK TRACT ADDRESS
Avi,-4
NO. OF BLDG$.
SIZE O€ LOTi!rl NOW ON LOT CITY TEL. NO.
USE OF
BUILDINCS DISTRICT NO. I GROUP
- MAP
_-CAP,
IBK PG
CONTRACTOR
ADDRES CONNECTION DATA
S —-----
STATION DEPTH
TEL NO,
Ty-AR4 MANHOLE
RErERENC
E :-7
$TATE
REGISTRATION NO, Ll COUNTY
No. DESCRIPTION OF WORK FEE
TYPE OF CQN*i�CT(ON LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB t P.L. M.L.
-PUBLIC SEWER $3.5_0
L -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD $3,021-1 J
aviknEw'SE_EPAG_EP_1T,_D_RAINFIELD I 1 1- , , " F C NO
FXTN.,Cc'SSPOOL,DRYWELL,NIANRC)LE Co $2.00 CO, IMP. NO. C.
-HOUSE SEWER CONNECTING 70
TR NK NO.
PRIVATE DISSAL SYSTEM ( U
CONNE-CTADDPOIONAL BLDG.OR STATE ENCPERMITACHMENT ROAD PERMIT NO.
'24 WORK TO HOUSE SEWER d $1.0,q PERMIT NO-
RO
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM INDUSTRIAL
WASTE APPROVAL CHARGES
CONNECTION CHARGE. FEE
OWNER'S PERMIT g 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FE ��1,
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS r)AE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
10 7,.E
PUBLIC SEWER. 4 NEW HOUSE SEWER
SIGN.,TH,,____.,C
e.)_PAY OF --19
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNE13S AGENTSEPTICTANK,SEEP,PIT($)
AND/OR GRAINFIELD
I HEREBY ACKNOWLE A HAVE READ 141S APPLICATION CESSPOOL;, DRYWELLO
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND;'OR
`OR DISCONNECT PLUG AND
LICENSED AS REZUIRED BY LOS 4Z ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CAL.:, CR THAT I �Aj If LEGAL OWNER OF THF ABOVE
DESCRIBED RESIDENTIASLOPERTY, BACKFILL SEPTICTANKSO
SEEP.PIT UCESSPOOLS J-1
SIGNATURE
I OF PERMITTE
JOHN A. LAME31E.CXNTY E'(4GINEER .1--VALIDATION ROBERT A.WOOD, CHIEF FLEIG. INSPECTOR
CASH
4 61 0 7