HomeMy Public PortalAbout5247TEMPLE CITY BLVD_Sewer (2) i
OEPAIVfMENT OF COUNTY ENG]NEM , It SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF L,O$ ANOELEB
WILLIAM J. FOX. COUNTY ENDIN[[R BU ILDINB
ADDRESS CA.�
/.FOR//APPLICANT TO ILL ! LOCALITY —
AD14,
DREI D 1•T 7 p� OSS NEAREST
CRST
LOCALITY DISTRICT NO SERIAL NO / PERMIT 0.
NEAREST A /(p �2s
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CROS �(A jam.
EIVED Y �RfW ipp'atlro i��T^8N1[4-1 J
OWNER L
NAIL
ADDBESS �8/y1..� USE 20NE �OCCUPAMCY BK YAP PD
CITY TEL NO _ '(l___!))�^�f.J,,.���1 f '
CONTRACT& C. Nottingham Co. of Temple Cly I '
CO IMP NO
ADDRESS 5933 N CLOVERLY AVE.
TMPOE Joe NO
CITY TEL NO TRUNK PERMIT NO
REGISTRATION NO 7 B COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL I
WASTE APPROVAL
SIZE OF LOT NO OF BLOBS
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ 8 SNI RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLOB OR EXCEPTION RECORDED
WORK TO HOUSE SEWER - 100
ALTER ON REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AMD/OR DIBP LSYSTEM 100 CONNECTION DATA
SEPTIC AM EEPAG PIT R
PITS AND/OR RAINFIEL 2.00 STATION DEPTH
CE FUQL RYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
1 TYPE OF CONNECTION LENGTH FROM
OWNERS PERMR ; I I 00 Y CURB PL M L TO P L
AUTHORMATION TOTAL FEEIwo
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED 0
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _.__ _ _ __ _ _ __ __ _ _ _ BUILDING OR WORK
SEPTIC TANKK,,BEEP PIT(8)
ADDRESS _ IAND/OR BRA NFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- iCESSPOOL Q-URYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE I
TO COMPLY WITH ALL COUNTY ORDINANCES AND BTATE LAWS 'ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPS L SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AMD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOU8ESAND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIPENTIAL PROPERTY RACkF L CTAN I''1
�-� SEEP PIT(B)o CESSPOOL
SOP PERMIITTTE h C�
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