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 ��