HomeMy Public PortalAbout6306-6308 TEMPLE CITY BLVD_Sewer__ )[uM.TD
ilIfV mE APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
SIEMENS
FR
OR APPLICANT TO FILL IN DUTKKT RD K31
MAPPGso E L� 1508 i�e�l
LITY CONNECTION DATA
EST STATION � DEPTH
UPPe arMANHOLE REFERENCE OW R
/� LOWER
ER /J MAILr TYKE OF CONNECTION ML.TO L.MAIL
RESS Z� Y CUREPLMETOPE/ CO IMF NOJOB NO
EGAL TNUNKPERMRNO ROADPIRMRNO
RIPTION LOT NOAPPIDAVR WAIVER EASEMENT RECORD INBTR NO OAT!
R rRACTNOOFeLDGe
OFLOT HOW ON LOT HWY OR ST WIDENING
OFDING3 / STATlENCROACHMENT
TRACTOR WASTE MPROVALREifCHARGES
TaLNO _ CONNECTION CHARGE FEE
! LIC REIMBURSEMENTFBE
NSE NO CLASS
DESCRIPTION OF WORK FEE APPROVALS DATE IN SIG TURE
HOUSE iE WER CONNECTW O TO
PUBLIC SEWER
SEPTIC TANK SEEPAGE PIT OP NEW IgUBE SEWER /►' rVVV
PRE AND/OR DRAINPIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSALSVST[I11
SEPTIC TANK SEEP PITISI
CONNECT ADDTONAL BLOO OR AND/OR GRAINFIELD
WORKTOHOUSESEWER
OVERFLOW SEEPAGE PR GRAINFIELD CESSPOOL 0 DRYWELLO
E CSSSPOOLDRYWCLLMANHOLE
ALTER REPAIR OR ABANDON HOUSE ALTER REPAIR SEWER OR
BEYYER OR DISPOSAL EYaT[Y
SEW AOB DISPOSAL SYSTEM
DISCONH[CTPLUOAND
ABANDON HOUSE SEWER
BACKFILLSEP IC TANKS O
OWNER'S
Permit i SEEP PRIBN❑ CESSPOOLS
AUTHORIZATION TOTAL FEE 79
� � /-T � � � VA�LID))ATION
I HAVE AT THIS DATE A CONTRACT WITH THE HERERN HAMED COH (/T/L/�L/"�� (.I/ ��
TTRACT6 R TO CC 6 WE p THa ABOVE GEscRI9lD EAISTIND DWawgG 31 29.9A
THIS DAY OF 1fi
OWNER M
OR T
' i ! i i 1 0
OWNER
owgnRB AGENT
wDOREas
2 • • 1800
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATK)H { { { 1 8 0 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDWANCni AND STATE LAWS REGULATING
PLIIMHERSEYN CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR 1114-78
LICENSED AB REWIRED BY LOS ANGELES COUNTY AND STATE OF
CALIPORNNA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RE
Son W THE ABOVE DESCRIBED RESIDENTIAL.PROPERTY
SIGNATURE _
OF PERMIIT6
aewe.aD
y
eSM
MORN en8l APPLICATION FOR PERMIT
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND'SAFETY
FOR APPLICANT TO FILL IN DSTAKT No DRouP MM PR D BY
ADo EBB(o3 Of
G NNECTION DATA
N[AMST STATION DEPTH
CIIOBB 8T UPPER
MANHOLE REFERENCE LOWER
OWNER TYPE OF CONNECTIONLENGTH FROM
Mw4. Y CURB PL ML TOPL
ADDRESS Z.� P C NO
CRY TEL NO dm"mlslo
CO IMP NO - Jon NO
DESCRIPTIONDESCRION LOTNOwPIIDAVR WANER EASEMENTRECORD INBTR NO OAT¢
BLOCK TRACT
NO OP SLOGS
SREOFLOT NOW ON LOT HWY OR ET WIDENING
USIOPBUILDINGS STATIENCROACHMHNT
L` INDUSTRIAL
CONTRACTOR �C"VA- WASTE APPROVAL /
ADDRESS CHARGES
CITY TEL NO CONNECTION CHARGE FEE
STATE LIC RCMBURSEMENTPEE
LICENSE NO CLASS
NO DESCRIPTION OF WORK PE■ APPROVALS DAT! INSP
HWSLI¢SEWERCONNECTINGTO /
PUBC SEWER _ -
[lTN
CTAKSEEPAGEPITOR NEW HOUSE SEWER
PRS AND/OR DRAMPIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
ONN[tt AL ELDG OR BEPTK:TANK SEEP PITI81
U66 6 AND/OR ORAINPIILD
OVERFLOW SEEPAGE PIT DIUINFIILD CESSPOOL ❑ DRYWELL❑
BXTN CESSPOOL DRYWELL MANHOLI
ALTER RI PAIR OR ABANDON HOUSE ALT!R REPAW SSWEROR
SEWER OR DISPOSAL SYSTEM SEWAOB DISPOSAL SYSTEM
-� DISCONNECT RUG AND
ABANDON HOUSE SEWER
BACKPILL SEPTIC TANKS❑
Permit E BEEP PITI81❑ CEBBPOoL ❑
OWNER'S
AUTHORIZATION TOTAL FEE 7b - VALIDATION_
1HAVE AT THIS DATE A CONTRACT W THE HEREIN HAYN ED CO / // / c Q� (� a. / 6 -7 9 -�
TRACTOR TO CONNECT THE ABOVE DESCRIBED WWW`��""��-
TOTHE PUBLIC SEWER
SIGNEDTHIS- DAY OP 19_
OWNER DR
OC • • 1 aoo -
WNERE AGENT
ADDRESS ! S I 1 aoo L
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND
WWITHBALL COOUUrTTYY ORDINANCES AAND SSTATTED LAWIS EREGULATINNG 11. 14-78
PWYB RE ANDERWERH --
1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR
LICCALIFORN AS REQUIRED I BY LOS AL ELESOWNS COUNTY AND STATE OF
SIIEINT E OBTHATIAM THELEGALOWNER P AND INTEND TO RL
SD)[IN THE ABOVE DESCRIBED RIBIDENTIAL�RTY
SIGNATURE -
OP PIRMIR[l