HomeMy Public PortalAbout6311 TEMPLE CITY BLVD_Sewer__ "A°'t°
u°o°a to APPLICATION FOR PERMIT
COUNTY OF LOS AN6ELE8 SEWER-SEWAGE DISPOSAL
MAHTUM OF COUNTY ENG&EER
BUILDING AND SAFETY DrMON BUILDING
JOHN A. LRIkGM County lkwh� ADDRESS
CASSATT D. ®IFFIM, Bv't of BuxiV LOCALITY
NEAREST
H AK IQ CROS!ST
LEGAL
DESCRIPTIO LOT NO OWNER
BLOCS TRA T RAIL
ADDRESS
0 OP BLD6S.
!aR OF LOT NON OX LOT L O
USE OF
EUdL—
CONTRBUILDACTOR/
DISTRICT NO UP YAP PROCESSED By
CONTRALTO � BE
PD
ADDRESS81
'CONNECTION DATA ,
CITY TE 0 STATION/ DEPTH ! _
ATE MANHOLE REFERENCE / U
REGISTRATION NO COUNTT LAMER
No D R R FEE _
PIOIBL�Ie SEWER #3
TO Q 3 t
SEPTIC
-30
ANS/OR DRAINFIELDT OR 3 00 TYPE OF
X P L.
LENGTH FAOM
OVERFLOW SEEPAGE PIT DRAINFIELD r O P
EXT
CESSPOOL DRYIY�LL MANHOLE
200
HOUSE SEWER CONNECTING 70 P C NO
PRIVATE DISPOSAL STSTEM T 00 CO IRP RO JOB NO
CONNECT ADDITIONAL BLDG OR THUNK PERMIT NO ROAD PERMIT NO
W��O��REEKRRTOg HOUSE SEVER�pp 100
SEVER OR DI SWR
STWX HOUSE I OO STATE ENCROACHMENT
bP0 LL STE PERMIT NO
XDUSTREAL
IAPPR
CHARGES
OWNS M PERIM 2 00 CONNECTION CHARGE FEE
AUTI'IOB=TION I TOTAL FEEREttHURSEYERT FEE
U C
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIK NAMED C N APPRQY DATE INSPECTOR D SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED TN AT OF g_ NEW xousE SHWKR
OWNER OR ♦ CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADURsty SEPI C TANK,SEEP PIT(8)
AMD OR DRAINFIE LD
1 MEREST ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AORKE TO COMPLY CESSPOOL EJ DRTTELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEVER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL S"TEY
1 HEREBY CERTIFY THAT 1 At PROPERLT REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED By LOS ANGELES COUNTY AMD STATE OF ABANDON HOUSE!EWER
CAIIFORXIA OR TNA i AY TX OWtl� 0! TER ABOVE
DESCRIBED RESIDE P80P BACKFILLCTANKS 0
Zn6PATURE BEKP PI7I! CESSPOOL!
0 FERMI
4k AImA1TON ROBERTA.WOOD
tK. L i GYIf SUPSMIGN10 IIMCIIANICAL HNOINSBUi
' U&1937r, AM311 0A 5.00