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HomeMy Public PortalAbout5746-5748TEMPLE CITY BLVD_Sewer - DEPARTAUPxT of COUNTY >IINOnvFXRSEWER—SEWAGE -DISPOSAL `DIVSlON-OF BUILDING_AND SAFETY_ '' PERMIT APPLICATION COUNTY-OF Los ANG=ff WILLIAM J. FOX, COUNTY EN13INEER BUILDING r� 1 ` �+ ` I ADDRESS , '1-4C,7::1 �C� �1 ��PI u��1� I BUILDING FOR APPLICANT TO FIIN NEAEST ADDRESS y" / D �I d CROSS ST. VylnznvN LOCALITY DISTRICT N0. SERIAL NO. PERMIT-NCO. NEAREST A }C� --s CROSS ST. ECEIVED BY Ready for Inspectlo_a DATE ISSUED OWNER MAIL ADDRESS _ ^USE Zd •OCCUPANCY BK MAP PG CITY j TEL.NO. CONTRACTOR {'� j p ,4pA44ffG�/! CO.IMP.N0. ADDRESSQD JOB.N0. —� CITY TEL.NO. .Z7/;? TRUNK PERMIT NO. sfrATE REGISTRATION NO. ROAD PERMIT NO. LEGALr STATE ENCROACHMENT DESCRIPTION LOT N0. • PERMIT NO. BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT1 / '� NO.OF BLDG& 40X/ S NOW ON LOT CHARGES USE .0017 IeL BUILDINGS 449p, p CON NECTIO RGE FEE N0. DESCRIPTION OF WOR FEEHOUREIMBURSEMENT FEE PUBLICSEWEB E SEWER CONNECTING TO III $ 3,60 RECEIPT NO. AZE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 WORK CONNECT HOUSE ODITISEWERLDG:OR 1.00 , EXCEPTION RECORDED ALTER OR REPAIR EXISTING NO. I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 .DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 "�.! CONNECTION DATA SEPTIC TANK,SEEPAGE-PIT OR PTHP -CESSPOOL—D RYW ELL SPECIAL CONDITIONS ONLY 2.00MANHOLE REFERENCE -/f UPPER LOWER -P OF CONNECTION. LENGTH FROM OWNERS PERMIT CURB P.L. M.L.TO P.L. ' �,. AUTHORIZATION=- TOTAL: FEE 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNE T THE ABOVE DESCRIBED XISTING APPROVALS INSPECTOR'S'SIGNATURE DATE DWELLING TO THE P LIC SE SIGNED THIS O _.��_ _ NEW HOUSE SEWEROWN ` CONNECT ADDITIONAL OWNERSN AT.�.. � _ BUILDINGORWORK SEPTIC TANK.SEEP.PIT(S) ADDRE88... �5:�._. ._(._. ... AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT IVE'READ THIS APPLI- CESSPOOL[3 DRYWELL CATION AND STATE THAT THE ABOVE 8 CORRECT..AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING D SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY AT 1 P REGISTERED AND/OR LICENSED QUI 0 A GELES COUNTY DISCONNECT PLUG AND AND STATE OF CA IA HE AI: OWN. ABANDON HOUSE•SEWER _ ER OF THE AB CR TI 'L P P RTY. BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)[:] CESSPOOLS OF PERMITTE - .... - .... _.._._. _.: 76A642A 663 7/53 ��