HomeMy Public PortalAbout5817TEMPLE CITY BLVD_Sewer 76A642D '��■ �'�I"6 ■ 'Ot:■ is■-•!-■
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5aE-66812•!54 SEWER--SEWAGE DISPOS
DIVISION OF BUILDING AND SAFETY
Department of County Engineer iLD1NG
County of Los Angeles `DRESS
WM. J. FOX, COUNTY ENGINEER
CASSATT D.GRIFFIN,SUPT OF BUILDING -CIALITY -----------
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PO; APPLICANT TO ML IN .AorsREST ST, ------ -----`-=
LEGAL iVVER
CES CR LFa,)N LOT - --
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BLOCK TRACT
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LOT
N04 ON LOT "Y
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USE OF STRICTNO. 4 GROUP BIC �MA
BUILDINGS
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CONTRACTOR _._...._____----- '
— CONNECTION D.'�T
ADDRESS .
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TEI-, Hr ATION -" -
q1T- -- - N ,FEFEAENCE
(.PP's
COUNTY „�, - ,d NO, --
P.EGISTRATIO!v ._ GTH FROM
- TYPE OF CONNECTION' LEN
`P.L.';'•_-___-_M- ..,.... P.L.
_- -
No. ! DESCRIPTION OF WORK FEE --
- I HOUSE SEWERCONNECTING 70 � $_3.50
I PUBLIC SEWER -- --
' t;OUSE SEWER CONNECTING TO 1.00 ' —`-"—�- --
PRIVATE DISP)SAI.SYSTEM I-----
JOB NO.
---L OR
I CO. IIA P. N0.
CONNECT ADDITIONAL BLDG. - --___"- _—�-----._.
�_WORK TO HUUSE
SEWER 1_00_ _---
I� UNK PERMIT NO. ROAD PERMIT N0. _
^� ALTER OR REPAIR EXISTING 1.00 _ _ - --f---`
SEVfER OR O15_POS A_L_SYSTEM -__-.^a--I --ATE ENCROACHMENT
— SCONNIECT AND ABANDON SEWER
I.00
j DiAN_O/OR CiSP_O_SA_L_SYSTE_M .-. ---
i SEPTIC TANK, SEEPAGE PIT OR I-:OU57R!AL
OR_MDRAINFIELD 2.G0-� I--- ;,P,STE APPROVAL
CESSPOOL- DRYWELL CHARGES.— _
SPECIAL CONDITIONS
- .---- i CONNECTION CHARCE FEE
��y���+p, PERMIT 1 00 --OWNER'S -------- }Fr!MSURSEMENT FEE
AUTHORIZATION i T-�L FEE _
PATE INSPECTOR'S SIGNATURE
I. HAVE THISAAPROVALS DATE CONTRACTED WITH THE HEREIN NAMED CON- �- --
'fRAC"TOR TO CONNECT THE ABOVE DESCRIBED EXISTING DbVELL!t(G
TO THE PUBLIC SEVER HOUSE SEWER
SIGNED THIS_._, DAY ;NN£CT ADDITIONAL
OWNER OR —,�— _Hj_!LDING OR WOR--_&_-_,__�_
OWNERS AGENT ----- -- .`-..—."�- S`=PTIC TANK, SEEP,PIT(S)
La` !OR DRAINFIELO -
J- 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION C5.SSPOOL❑ DRYWELL❑ —
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALTER, REPAIR,SEWER OR
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 5.„NAGE TIS_POSAL SYSTEN,Y__
PLUMBING AND SEWERS. _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF BANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ACKFILL SEPTIC TANKS 13
DESCRIBED RESIDENTIAL PROPERTY. EEP.PIT(S) O CESSPOOLS
SIGNATURE
OF PERMITTEE ------
WILLIAM J. FOX.COUNTY ENGINEER V ��
BY
DEPUTY
BY DEPUTY
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OGPaTY
BY
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