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Home My Public Portal About6326-6328 TEMPLE CITY BLVD_Sewer__ Twe.aD C IRenBi CDss EV APPLICATION FOR PERMIT SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY NEEDED BUFOR APPLICANT TO FILL IN BBTRicT ND STIOUP BK KsF I Fn ED BY (� a ILDING 3 Al / •• ADORES (� CONNECTION DATA NEAREST STATIO f�, 'DEPTH ' CROE6 BT v6 UPPER MANHOLE REFERENCE LOWER OWNER TYRE OF CONNECTION LENGTH FROM MAIL � / V CURB PL MLTOPL ADOR[es PC NO 1 c C TEL No L/!/ z 3 co IMP No ,oBNo LEGAL TRUNKPERMITNO ROADPERMITNO OESCRIFTgN LOT NO AFFIDAVIT WAVER EASEMENT RECORD RNSTR NO DATE SLACK TRACT L NO OF BLDGS ls1 OF LOT NOW OH LOT HWY OR ST WIDENING USEoF BUILDINGS STATE ENCROACHMENT PERMIT NO CONTRACTOR IIE)UETRIAL WASTE APPROVAL ADDRE88 CHARGES Cm, TEL NO CONNECTION CHARGE FEE STATE LIC / RRBISURSEMENT PEE LASS LICENSE NO C NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGN TUR HOUSE SEWER CONNECTING TO PUBLIC SEWER Py SEPTIC TANK SEEPAGE PIT OR NEW HOUEl6EW8R FRB AND/OR DIWNPIBLD CONNBCT=14AL NW 8E SEWER CONNECTING TO BU BDING OR WORK PRIVATE DISPOSALSYSTEM 3—'CT ANK 86EP PTTISI CONNECT AODITgMAL pLDO OR AND/OR RAINPIEIA WORKTOHOUSESEWER - — OVERFLOW SEEPAGE PIT DRANFIELD CESSPOOL ❑ DRYWELL❑ ff r C88SPOOL ORYWELL.MANHOLE ALTER REPAIRORARANDONHOUSE ALTER REPAIR SEWSROR SEWER OR DISPOSAL BYETEM SEW"Is DISPOSAL SYSTEM DISCONNECT PLUG ANO A- 4DONNOUS[SBWER KLL RACFISEPTIC TANKS❑ - OWNER'S Permit B 7 .—. BEEP PITLII O CK55PcoLD❑ AUTHORIZATION TOTAL FEE / VAUDATIO 7 I HAVE AT THIS DAT\ A CONTRACT WITH THE HEREIN NAYBD COX 1 — ' Q•� IFI TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWBWNG TOTHE PUBLIC FEWER SIGNEDTHIS DAYOR iD_ OWNEROR OWNS RB AGENT ADDRESS I HEREBY ACKNOWL8DGl THAT 1 HAVE READ THIS APPLICATIONANI) ATE THAT THE 1 TTH�ALL COUNTY ORDIONANCES AND STATE13 CORRECTD LAWS B TO COMPLY WREGULATING PLUMBINOANDBEWERS — + 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENBED AS REWIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RE _ BIDE IN THE ABOVE DESCRIBED RIBIDENTLIL PROPERTY SgNATURE -- OPPERMRT6 TweRRD A I FJTT ¢ es SOB(REV 6/181 APPLICATION FOR PERMIT SEWER - SEWAGE DISPOSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DBTIIKT NO GMW P MN 1 P SSED S J 1 .9 &/ Pc euILOING Iv ADw+¢sa CONNECTION DA cN AREBr STATION3 t7 DEPTH CROSS BT L6 UPPER MANHOLE REFERENCE IDWER OWNER TYPEOPCONNECTHDN LBNGTH FROM MALL ^A Y CURB PL MLTOPL ADDRQpp ,J' PC NO CRY TEL NO Z CO IMF NO JOS NO � LEGAL TRUNK PERMIT NO ROAD PERMIT NO DEECRIFIION LOTNO AFFIDAVIT I WAIVER EASEMENT RlCORO INBTR NO DATH BLOCK TMtt NO OF BLDGS SO OF LOT NOWON LOT HWY OR ST WIDENPIG STATE US[M SRMIT ouLL NGS PNCROACNM[NT [RYrt NO f INDUSTRIAL CONTRACTOR c / WASTE APPROVAL ADDRESS CHARGES CT' TQL NO CONNECTION CHARGE FEE STATE LIC REIMBURSEMENTFEE LK:ENSa NCI CLA88 No DESCRIPTION OF WORK FEE APPROVALS DAT[ INSP[Cr SSIQ A HOUSE SE WBR CONNECTING TO PUBLIC SEVIQR NEW NOUS[flWQR PEPTIC TANK SEEPAGE PR OR HPITSOU ANG/GTI GRAINFIELD CONNECT ADDITIONAL NOUBHSEWER AI_SYS TIM TO BUILDING OR WORK PRIVATE D1BPp8AL SYSTEM CONNECT ADDRK)NALBLDO OR SEPTICTANK BEEP PRIG) WORK TO HOUSE SEWER AND/OR DRAINFIELD OVERFLOW SEEPAGE PIT DRAINFIQLD CESSPOOL ❑ DRYWRL O EKTN CESSPOOL ORYWELL MANHOLE _ ALTIR REPAIR OR ABANDON HOUSE ALTAR REPAIR SEWER OR !EWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILLSEPTICTANKaO -- OWNER'SSEEMS Permit f SEEP PITISI❑ CESSPOOLS❑ AUTHORIZATION TOTAL FEE VALIDATION I HAVE AT THIS DATA A CONTRACT WITH THE HEREIN IRIIYQD CON W`t✓� — TMCTOR TO CONNR&TNS AMOVH DBSCRIBED EXIB OWELLINO 13 Q 6 A TOTHE PUBLIC SEWER SIQNEDTHIS DAY OF 19_ # • • • • 1 0 OWNER OR OWNERSAGENT _ rT P • 1 UO O oI ADDRESS C ry I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION • • • � ` rj O c AND STATE THAT THE ABOVE I8 CORRECT AND AGREE TO COMPLY WITH NINI O COU�ERfINANCHB AND STATE LAWS REGULATING 1 HEREBY CERTIFY THAT I AM PROPSMY REGISTERED AND/OR LICENSED AS REQUIRED BY L ANGELES COUNTY AND STATE OF CALIFORNIAORTHATIAMTHELEGALOWNEROF ANDINTENDTORE SION IN TM[ASOVC DESCRI8ED RSf IDENTIAL PRO SKINATUR[ - OP PERMITTEE