HomeMy Public PortalAbout6123-6125 TEMPLE CITY BLVD_Sewer__ >6AE-6 C7 APPLICATIONS FOR
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DIVISION OF BUILDING AM SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING ' — -
`1NM.J. FOX. COUNTY ENGINEER ADDRESS =—
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CASSATT 0.GRIFFIN,SUPT OF BUILDING `LOCALITY �
FOR APPLICANT TO FILL IN CROSS ST � r
LEGAL u "jam = '� C /
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DESCRIPTION T NO OWNER !' r
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FLOCK TRACT� r -- MAIL
_ADDRESS.
NO.OF BLDGS_
`SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF.
_6UILDJNGS _ DISTRICT NO, CROUP MAP -
-_ I BK PG
CONTRACTOR .
ADDRESSCONNECTION DATA
` /.( ".� 1 C--- 3
CITY TEL. N0.
. --'.'�% STATION DEPTH
1J STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ,j ^-- f'' .'�,r �- �j COUNTY
No DESCRIPTION OF WORK FEE
- -- I -- TYPE.OF CONNECTION LENGTH FROM
�C MOUSE SEWER CONNECTING TO Y.,_ _ CURS P L.-^ h7 L. TO
PUBLSEWER (7i,
—1 IC HOUSE SEVER CONNECTING TO
1 PRIVATt_D 15POS 1L SY,TEM _
CONNECT ADDITIONAL BLDG. OR ��--,, P. C.NO. �I
WO,K TO HOUSE SEWER_ �- I_0 --
Ci �'_ CO. NO____ JOB NO.---`-
ALTER OR REPAIR EXISTING
i SEWER OR DISPOSAL SYSTEM 1.00_I TRUNK PERMIT NO, ROAD PERMIT NO.
D SC76MNECI AND ABANDON SEWER STAT ENCROACH'MENTv
Ai C./OR DISPOSAL S`� TEh1 _I.QO _FERMN7 NO,
SEPTIC ZANY SEEPAGE PIT ORPITS_AND/OR DRAINFIELD E-3_00 INDUSTRIAL
CESSPOOL DRYNEI L WASTE APPROVAL
�PL'C[AL CONDITIONS ONLY 2.00 CHARGES —
04YPFEW PERvITT ~ 1 CONNECTION CHARGE FEE --
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AUTHORIZATION TOTAL F££ i ''w V REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED V41TH THE HEREIN NAMED CON- �+ }}
TRACTOR. TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE (INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
-- `�`.".–i"'---------- --`----
SIGNED THIS---DAY OF 19- NEW Haus SEWER -- --
OWNF,R OR CONNECT ADDITIONALOWNERS AGENT-- -
BUILDING OR WORK -
SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING
ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSI'E'AJ
IHEREBY CERTIFY 'THAT I .AM PROPERLY REGISTERED AND/CR —""-'-- ----- - '"
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEINER __ _ _
DESCRIBED RESIDENTIAL J,IOFERTY.
'/ �. BACKFILL SEPTIC TANKS(J
SEEP. PIT(S) 0 CESSPOOLS 0
SIGNATURE
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FF PF_t2M iTTE * l
WILLIAM J.FOX,Coup'_ ENGINEER VALIDATION R.A.'WOOD,CHIEF PLBG. INSPECTOR