HomeMy Public PortalAbout5422TEMPLE CITY BLVD_Sewer (2) DEPAKTMENT OF ooIInrrY ENGTNEE[i SEWER-SEWAGE DISPOSAL, 7
brvISIbN OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS �•4�7 T�p�._I p ,� �`y�, ��i
FOR APPLICANT TO FILL IN LOCALITY 1 {S1
BUILD'NG ,p NEAREST
ADDRESS -5 �� 1 T'eM rI�TV CROSS ST G
LOCALITY TQ/H d/�'TY �7 DISTRICT NO SERIAL NO Pfixtl1T NO s
NEASEST F-/ �-/ A ►
CRO88 BT
CEIVED BY RadT tw IoNNwIIoe DATE ISSUED
OWNER 4 r_ f T / I�n o-+N.L� /✓ � _
M AIL ADDRESS -,-- .,2� % O Y USE ZONE OCCUPANCY BK YAP PG
CITY / eM I7/� C,�i L No
CONTRACTOR at j 12r f-AA W f L. 64tiST. CO IMP NO 1xp 1 �3
ADDRESS 170Imo•+ JOB ND
CITY L p 11i TEL Ng Mu - LrCZ TRUNK PERMIT NO
STATE
REGISTRATION NOCOUNTY ROAD PERNIT NO
DEBCH L Ir LOTN 3'y7•YY OT STATE ENCROACHMENT
PERMIT NO
BLOCK + TRACTMISS/O IV G N/ INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF SLOGS
�a $ I T-0 NOW ON LOT CHARGES
USE OF
BUILDINGS 16A CO TION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMSURSEME E
HOUSE SEWER CONNECTING TO
PUBLIOSEWER S 850 RECEIPT NO DATE
USE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM IOD
0 NNECTAODITIONAL BLOB OR EXCE ECORD
WORK TO HOUSE SEWER 100 00 N
ALTER EPA' EXISTING DATE B
SEWER OR DISPOSAL SYSTEM 100
DISCONN TAND ABANDON SEWER
ANO OR 018POSAL TEY 100 CONNECTION DATA
P 1BY8
T
6 ANK 8 SPAS IT on
PITS ANO OR GRAINFIELD 4.00 STATION DEPTH
SPECIAL CONDITIONS ONLY 4-00 YAMXOLE E
�6R LOWER
TYPE OF IMECfFoN LENGTH
OWNERS PERMIT f I 00 Y RB P L Y L TG P L
AUTHORIZATION TOTAL FEE 2 n v Conn 1
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGN ...DAY F_ 9 NEW HOUSE SEWER
OW NE CONNECT ADDITIONAL
OWNS ENT. _ BUILDING OR WORK 3�
ADDRESS—7-9217
EPTIAND/OR DRAT MFIELD IT(8)
1 HEREBY ACKNOWLEDGE THAT I HAV READ THIS APPLI- CESSPOOL[:] DRYWELL[3CATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED
AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOB ANGELES COUNTY ABANDON NOU8EBAND
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BAC ANK
SIGNATURE BEEP PIT(S)[] CESSPOOLSD
OF PERMITTEE.
7SA84U 60 7/59 �!�i