HomeMy Public PortalAbout6418 TEMPLE CITY BLVD_Sewer__ 146!0 M
79AG41D APPLICATION FOR PERM
1UUAn COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSA
DEPAWMENT OF COUNTY ENGINEER
B�II��M�TDpDTiG AND SAFETY DIVISION BUILDING
VPDd�EBE�A. Jmm,&.L_p W=14
LOCALITY
NEAREST
FOR APPLICANT TO FHl IN CROSS ST
DESCRIPTION LOT NO — J�gIl OB'NER
BLOCK TRACT MAIL
ADDRESS
NO OF SLOGS
S12E OF LOT NOW ON LOT CITY TEL NO.
USE OF
BUILDINGS DISTRICT NO GROUPjNNMMMMM YAP PROC BT
BE
PG
CONTRACTO
ADORE r CONNECTION DATA
CIT� TEL NO STATIO DEPTH
-ITATEPPER
REGISTRATION NO 804"d COUNTY
No I DESCRIPTION OF WORK FEE
OUSE SEWER CONNECTING TO
USLIC SEWER 3 00 TYPE OF TION LENGTH FROM
SEPTIC TANK SEEPAGE PIT OR Y CURB P L Y L iD P L
PITS AND OR DRAINFIELD 3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
M CESSPOOI ORYWrLL
HOUSE SEW ER CONNECTING TO P Be NO
IVAT L SY f 0 CO IMP NO JONO y
CONVECT AOOITIONALBLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORN C HDDIJ 99EEWWEE a SI Do
A T NP
OR ABANDON HOUSE STATE ENCROACHMENT
SYST $I 00 PERMIT NO p
INDUSTRIAL
WASTE APPROVAL
C
OWNERS PERMIT Z 00 CONNECTION CHARGE FEE
AumoB=TION TOTAL FEE HEI MBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR PSIGNATURE
TO THE PUBUC S
SIGNED THI A OF NEW HOUSE SEWER
OWXER OR CONNECT ADDITI ONAL
OWNERS AGENT BUILDING OR WORK
ADDRE SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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 SEWEROR
FLUBBING AND SEWERS 9LTER REPAIR
AL EROR
I HEREBY CERTIFY THAT I AY PROPERLT REGISTERED AND/OR DISCO E EC DISPOSAL
PLUG AND
YSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP ABANDON HOU9EG AND
CALIFORNIA OR THAT AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN L ROPERTY BACKFILL SE C TANKS
SIGNATURE SEEP PIT(S) CESSPOOLS C
OF PERMI
mT MMATION ROBERT A WOOD
CL ■ 0 CAAH SUPERVISING MHC:NANICAL MNGENEM
U�,� 207ZB SEP 271 G D 5.0470 " /