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HomeMy Public PortalAbout6350 TEMPLE CITY BLVD_Sewer__ 7SAG42 D APPLICATION FOR ERMIT C 11806 COUNTY OF ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT COUNTY OF ENGINEER BUILDING AND SAFETY DIVISION eu1LDINo 3J"o Wm A LARD. aunty ES . ADORE86 Ze •YI11LL'1'-'A`_M_ A. PMEN. B.p of BwIMDY . G LOCALITY N[AR[aT LEGAL FOR APPLICANT TOFU L IIV DO O� Deacnlmon LOT;;;:f- / owXefl MAIL BLOCK TFIA—Af J p ADDRfee /��/ NO OF BLO08 SIZE OF L JV NOW ON LOT CITY NO USE 01 DISTRICT NO OROUF MAP PROCESSED BY eUILDIN66 ,�IF� 1061 /' (J(\/7 eK _ CZ r \Y CONTRACTOR ✓✓" ADDRESSCONNECTION DATA CITY TEL B 1- -ATION 'DEPTH .2 STATE MANHOLE nEFERENc6 UPPER REGISTRATION NO COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENaTH•FRO y HOUSE]EWER CONNECTING TO Y CURB P L N L TO P L PUBLIC SEWER [S 00 O SErtIC TANK E[[PAOE PIT 011 FC NO PEPTIC ORAINFIELO 0 [1000 CO IMP NO JOE NO BE MOUSE SEWER CONNECTING TO T11UXK PERMIT NO ROAD PERMR NO OD PFIVAT[OISPOSAL SYSTEM ® J]CO 14 CONNECT ADDITIONAL BLDG OR AFFIDAVIT MTO uu[[T RECORD 'MSTR XO DATE WORK TO HOUSE SEWER 5300 OVERFLOW SEEPAGE PIT GRAINFIELD h [NTN CESSPOOL DRYWELL MANHOLE Q 5500 Z ALTER REPAIR OR ABANDON HOU[f HWY ORST WIDENING SEWER OR DISPOSAL SYST M 53 00 [TATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OMrNMVS PERM f 2 00 CHARGES AV HORMATION TOTAL FEE CONNECTION CHARGE FE[ IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PU ELIC SEWER A"RmmnOV TU PATE INSPECTOR 6SION RF SIGNED THIS A"F OWMER OR ,/Y/ NEW HOUSE SEWER (QJ OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 6EPTICTANK SEEP PITO) ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUM DING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HERESY CERTIFY THAT 1 AM PROPERLY REGISTER[ ANO/OR ALTER REPAIR S[W[R OR LICENSED Ae R[GUIR LOS ANGLE COUNTY ANO ATE OF S[WAOE DISPOSALSYSTEM CALIFORNIA OR THA A THE LEGAL ER OF XD NT[ND TO DISCONNECT PLUG AND RESIDE IN TH[ VE [SSRI SEO R NTIA RO RTY ASAND.H HOUSE 6[W ER SI01 PC MITT / SACKIILL SEPTIC TANKS ❑ SEEP PIT(S) ❑ CESSPOOLS PAL }{� ROBERT A WOOD M 0 � CK M O /cA/ /aH / SUPERVISING MECHANICAL ENGINEER L,.Lo 8 7 5 5G FEB 19 1 0 D 7.00- a At`L