HomeMy Public PortalAbout6261 TEMPLE CITY BLVD_Sewer__ e
APPLICAMON FO PERMIT
COUNTY OF LOS ANGELEe SEWER—SEWAGE DISPOSAL 1
DEPAHTDUNT OF COUNTY ENGURM
HDD.DING AMID SAFETY DIVISION BUILDING
ADDRESS
Tr D + LOCALITY
NEAREST
FOB APPLIC TO FILL Di CRO
LEGAL
DESCRIPTION LAT NO OWYER
BLOCK TRACT PAIL
ADDLES!
NO OF NLDGS
SIZE OF LOT NOW ON LOT TA N
USE DI DISTRICT NO GROUP MAY PROCESSED BY
BUILDINGS
�O B[ PG
CONTRACTOe
ADDRESS 7 G!/�Ci CONNEC170N DATA
CITY TEL NO .4/ STATION DEPTH
ATE MANHOLE REFERENCE UPPER
REGISTRATION NOg�t COUNTY LOWER
No DESCRIPTION OF WOR FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER f SS 00 TYPE OF CONNECTION LENGTH FROM
SEPTIC T�HK SEEPAGE PIT OR Y CURB P Y L TO P L
PITS AND OR DRAINFIELD 0 S3 00
00
OVERFLOW SEEPAGE PIT GRAINFIELD
DR La St 00
OUSE EVER CONN ECTIXG TO P C NO
1 AT 1 Y CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO NOU SE SEWER
ALT 100 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CXARG
OWNEB'g PERMIT A2 00 CONNECTION CHARGE FE[
ADTHOBPLATION I TOTAL 3 O D REIMBURSEMENTI HAVE AT DATE A FEE
CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED HEREIE[I BTNN OCT WITH THEADWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS TIAY OF' +9_ NEW HOOSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDR SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRTW[LL 11
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER RGPINI!•SEWZR4R
PLUMBING AND SEWERS •L
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AMD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AY THE LEGAL OWN OF THE SOV[ ABANDON HOUSE FEWER
DESCRIBED RES IAL P [BTT ACXFILLS[ CTANKS
SIGNATURE SEEP IT
D CESSPOOLS
OF PERYI E
®r _ VALIDATION ROBERT A WOOD
L L
C 0. CAL SUPERVISING AlEC:NANICAL ENGINEER
U!o°, :3 9 2 1.1.iD 3 .010
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