HomeMy Public PortalAbout6421 TEMPLE CITY BLVD_Sewer__ ceeoe lo-ea O APPLICATION FOR PERMIT
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COUNTY..OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eU1LOINO /
WMALAXIIIE C.On ERq�ow ADOREae
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REGISTRATION NO ❑ COUNTY
NO DESCRIPTION OF WORK FEE TYPE of C 'ON
LENGTH FRO
HOUSE{EWER CONNECTING TO r Y CURB P L M L TO P L
PUBLIC SEW" m SSW J �� d
a[rtic TANK 9[ PAcc PITCA P c No O
P ITB AND/OR GRAINFIELD Slo OO CO IMP NO JOB HO v
HOUSE{OWER CONNECTING TO TRUNK PERMIT No ROA RYIT NO
PRIVATE DISPOSAL SYSTEM SD Go O
CONNECT ADDITIONAL BLDG ON AFFIDAVIT WAIVE. ...DART REC INSTR NO DAT[
WORK TO HOUSE SEWER O DD OO
OVERFLOW 9EEPAO[PIT ORAINFICLD �V
C%TN CESSPOOL DRYWELL MANHOLE O SSOO HWr on ST WIDENING U Z
ALTER REPAIR OR ABANDON HOUSE
SCW[R OR DISPOSAL SYSTEM {a W STAT[ENCROACHMENT z
PERMIT NO
INDUSTRIAL F
WASTE APPROVAL
OWNER'S PERMIT s 2 00 CHARGED
AUTHORIZATION TOTAL FEE OO CONNECTION CHARGE FEE
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FE[
TRACTOR To CONNEC TH[ ABOVE e G
TO THE
PUBLIC D APPROVAL$ DAT[ INSPECTOR 9 SIGNATURE
SIGNED THUS AY 1 `,_
OWNER OR NEW HOUSE SEWER
OW NCM AO[NT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
1 HHRCBY ACKNOWLEDGE THAT I HAVE MCAD THIS APPLICATION �EPTJCTANK SEEP PITIS)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ANO/OR MAINFI[LD
WITH ALL COUNTY ORDINANCES AND {TATE LAWS REGULATING ❑
PLUMBING AND SEWERS [CESSPOOL ❑ DRYWELL1MERQBY C[RTIIY THAT I AY PROPERLY R[o1DT[RED AMO/ORf
EWER OR
LICENSED AS REQUIRED Y LOS ANGLES COUNTY Ary STATH OFL SYSTEM
CALIFORNIA OR THAT MTHE COAL OWNER OF A INTEND TOG ANDRIDIDE IN TNS ABO D[aCR o RC IO[NTIpLP RTY SEWERSIA (/ TANKS ❑C"arc,0 /
VALID Z-AD.)
ROBERT A WOOD
CK M o SUPERVISING MECHANICAL ENGINEER
L1C0 3 6 8 3 2 SEP 11 I O D 7.00- V
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