HomeMy Public PortalAbout6201 A & B TEMPLE CITY BLVD_Sewer__ 76A6420
S&E-663 1"Mr APPLICATION FOR PERMIT -zs- t -,-, c5
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAME31E, COUNTY ENGINEER _ADDRESS Te,&,r c
CASSATT 0.GRIFFINLI
, SP'T OF ElUiLDINO y
.00ALITY
INEAREST
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I SS ST.
DESCRIPTION OWNER If
FOR APPLICXNT TO CRO
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LEGAL ,d sro
NO
1AIL
ELOCK TRACT I ADDRESS
NO. OFBLDGS.
SIZE OF LOT4:�<V NOW ON LOT CITY TEL. NO,
USE OF
DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR pl'n' t
CONNECTION DATA
Ve
ADDRESS 225 7
CITY STATE _STA--ION DEPTH
TEL. NO. Gi 3-65"5 MANHOLE.
�N�H��7EIENII Of
N
168479 D
REGISTRATION .11' COUNTY
No.
DESCRIPTION OF WORK FEE
YPE OF CONNECTION LENGTH FROM
'HOUSE SEWER CONNECTING TO i^
Y� CURB P.L. M.L.T 0 P.L
PUBLIC SEWER @ $3,50
SEPTIC TANK,SEEPAGE PIT OR
PiTs"'fl?/ORDRAINFIELD qt $3,00
OVERFLOW P C' N0
EXTN.,CESSP00i,,I)RYWELL,MANI,',,��,E C4 $2.0 0 JOB NO�
HOUSE SEWERCONNECTING TO
PRIVATE DISPOS-A_L_S_YSrEM Co.. $1.001,__—i TRUNK PERMIT NO, ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR
STATE ENCROACHMENT
WORK TO HOUSE SEWER $I-o-3 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE 1 JIDUSTRIAL
',ENER OR DISPOSAL SYSTEM t x WASTE,APPROV�g4
CONNECTION CHARGE FEE
OWNER'S PERIMIT
1 00
AUTHORIZATION TOTAL FEE ---- REIMBURSEMENT FEE
'5—L'
TC
I HAVE AT DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS LATE iNSPECR'SSIGNATURE
TRACTOR TO CQNNFCT THE ABOVE DISCRirlfl) L-X!STiNG DIN ELLINQ
TO THE PHSLIC SEWER, NEW -HOUSE SEWER
SIG-NED TfflS---,-----DAY
CONNECT ADDITIONAL
OWNER OR �'UILDING OR WORK
OWNERS AGENT.------A---:��'
;EPI t.TANK,SEEP,PIC(Sli
AND.,'OR
I HEREBY ACK44OWLEDGE THAT I HAVE READ THIS. APPLfCATION
AND STATE 1HAT THE ABOVE !S CORRECT AND AGREE To "s4-1,C) LL] Dpyl E
COMPLY' "I LL L]
WITH ALL COUNTY ORDINANCES AND STATE LALV$ REGULATING ALTER.REPAIR,SEWER OR
PLU:4BING AND SF',1.'ERS,
SEW AGEDISPOSAL SYSTEM
I HIERE1.33Y CFR',IFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS RE DISCONNECT PLUS AND
CALIFORNIA OR. Q'UTRED BY L',!� ANGELES �-OUN-LINTY AND STATE OF ABANDON HOUSE SEWER
�'ij)F�HA'T I'R,'11 (HE LEGAL 011N,' ER OF THE ABOVE,'
�"T I RITY, LL SEPTIC TANKS E,
DESCRTSFI) RE BACKF�
SIGNATURE FER. P;TS) CESSPOOLS
OF PERMITTEE
-
JOHN A.3_AME31E,COU ENGINEER LIDATION ROBERT A. WOOD, CHIEF" PLBG, INSPECTOR
O. GASH
A
-15 1 7.50