HomeMy Public PortalAbout6307 TEMPLE CITY BLVD_Sewer__ "" aa APPLICATION FOR PERMIT
-VM TT OF LOS ANGELES SEWER—SEWAGE DISPOSAL
ARTBU T OF COUWY ENGUGM BUILDING/
�DUILDXNG AND SAFETY DriMON ADDRESS
JOHN A. LABS. Cemty HOGIww
CASEATI!D. OHSPSf, Sup I d i°DddQ -LOCALITY,
NEAREST
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LEGAL 14
DESCRIPTION LOT NO OWNER
BLOCK 7RACT a MAIL
ADDRESS
NO OF BLOGS .1
SIZE OF LOT NOW ON LOT CITY TEL NO 192
UBE OF
BUILDINGS DISTRICT NO 7CONMMMC=nON
PROCESSED BY
CONTRACTORr. 40
ADDaeae CTrc El Monte TEL NO GI 8-6 ReG14TRAnoN NO 168 STATTE OLK UPPER
NO DESCRIIP FEE
HUBLIC SS2.E&CONNECTING TO S 00
AND/RK SEEPA ELPIT OB SOO TiPE OF CFROJI7 p T CPL
O�YETNF CjVrE �AORTNELL Y MXOL6 200
ROUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IMP NO JOB NO
CONNECT ADDITION�I((11,,BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEMER 1 00
BEW6R OR DI9M9I1L 3Y4fEY HOUSE $1
00STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVA
CHARGES
Os FCONNECTION CHARGE FEE
AIImo=AnoN TOTAL FEEREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE AMED CON Ap OVALg DATE INSPECTOR 891GMATUBQ
TRACTOR TO CONNECT THE "BYE DESCRIBED DWELLING
TO THE PUBLIC SEWER
SIGNED THIS DAY OF )9_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OIS ERSAGENT BUILDING OR WORE
SEPTIC TANS SEEP,PTT(S)
ADD AND OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READPPLICATION
AND
STATE THAT THE A YE ID CORRECT AND TO COYPU CESSPoOL DRTWELLWITH ALL COUNTY ORO CES AND STATE EGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWAGE DISPolAL SYSTEM
IHEREBY CERTIFY T 1 AY P PERLY ED AND/OR DISCON NI PLUG ANO
LICENSED AS REOUIR BT LOB NG EII COUBYATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT A■ TN LE OWNHE ABOVEDESCRIBED REBID TI PROPERBACKFILL SEP
C TANKS❑
816NATURB SEEP PIT(S) 8C
IT 8 CESSPOOLS
Ed
OF PERMI
�. gyMMATION ROBERTA WOOD
C[ ■ G OAS[ SUPERVISING MECHANICAL RNOINQQR
LQ194ON Ate 311 1 A 25.00 :8
6 �0 -7;� e.. APPLICATION FOR PERMIT U d
vr,,�,•„��• OF LOS ANGFJ.I'Sffi SEWER-SEWAGE DISPOSAL 1
pp��ppA81bIENT OF COUN" ffiQGIIMM
TWHMI QG AND SAFETY DMffiON ADDDRESS13RM
1015011RS A. LAMM C &Wbmw A
CABBATT A 6IZFFM SRp'1 of B, LOCA1 Tf1'
Oa NEAREST
CROSS Si
LEGAL P.
DESCRIPTIONLOT NO OWNER
BLOCE TRACT MAIL
ADDRE99
0 OF BLOW
SIZE OF LOT NOW ON LOT CITY TEL
1"-
USE OF
BUILDINGS DISTRICT NO GROUP YAP PROCESSED BY
CONTRACTOR j BE PG
F a
^DOflESS Y-w CONMCIION DATA
CITY TEL R 4f Q DEPTH
-7 ATE DIX NCH UPP
REGISTRATION NO ! COUNTY D
NO D ION R FEE
PUBLIC SEYYERCONNfiCTING TO S 00
gEPPG T NK,SEEPAGE PIT OR Y TYPE OF CONNECTION
CTICN P ML GTO P
PITS AXD OR ORAI NF1 E LD $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EHTN CESSPOOL DRTWftL MANHOLE 2 00
HOUSE SEWER CONNECTING TO P C NO
PRIVATE DISPOSAL SYSTEM 1 00 CO IRP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEVER 100
ALTER REPAIR OR ABANppppN HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTlY 1 00 PERMIT NO
INDUSTRIAL
R H APPROYA
CHARGES
O�"s p'EgMIT S DD CONNECTION CHARD[FEB
AUTHOMAnON FTOTAL FEE REIMBURSEMENT FEE
I HAV[ AT THIS DATE A CONTRACT WITH THE HEREIN HAYED COR APPROVALS DATE INSPECTOR 8 B16NATuse
TRACTOR TO CONNECT THE ABOVE DESCRIBED ]EXISTING DWELLING DWELLING
TO THE PUBLIC SERER
SIGNED THISAY OF 1/— NEW HOUSE SEWER 1ti
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADD SEPTICTANK SEEP PIT(S)
AMD OR DRAINFIELD
I HERESY ACKHOWLEDG THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLUMBING AND SEWERS 4E WAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ARD/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUS AND
CALIFORNIA OR THAT 1 AN THH OWKKR OF TtlS ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT PROP BACKFILL SEPTIC TANKS D
SIGNATURE SEEP PIT 4 CESSPOOLS ri
OF FERMI
VALIDATION ROBERT A.WOOD
SL M.46 CAB SUPERVIGIN02SECHANICAL SNOINSSI2
La"'101939m AW 31 1 0 A 500 $