HomeMy Public PortalAbout5936 OAK AVE_Sewer__ DEPARTMENT OF COUNTY ENGngEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS "Gm"
WILLIAM J FOX, COUNTY ENGINEER I BUILDING
ADDRESS
T I
FOR 71.7 NT TO FI N LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIIT� S
NO c
NEAREST 49- A 3 5(P Q 3
CROSS 8T
R EYED BY Roady for Iaovnetlon DATE ISBUED
OWNER 0-13
MAIL ��,ONE I � /_OCCUPANC� ��PG
Lie;
NO
ADDRESS 6
CITY TEL.11101
coNPAV011111thnoham Ca« of SA.—Cal CO IMP ND
ADDRESS 5933 N CLOVERLY AVE JOB No
CITY TEMPLE CITY. CAMLN TRUNK PERMIT NO ----------
-T A_TE
---------
TATE
REGISTRATION NO � 7VL� COUNTY ROAD PERMIT NO 7V•
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMEN
S � � � PERMIT NO _
BLOCK TRACT & INDUSTRIAL
WASTE APPROVAL Tier,. a�`i c� e�x lu 1G�LbYa�w
SIZE OF LOT 6-0 NOW ON LOTS CHARGES �—
BUIILDINGS SE OF1 CONNECTION CHARGE E
NO DESCRIPTIM OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
UB
PLIC SEWER ® S 330 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISP09AL SYSTEM 190
CONNECT ADDITIONAL BLDG OR P&EPTION CORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING DA BY
SEWER OR DISPOSAL SYSTEM 100
AND ORNDISP 8A SECT AND YSTEM SEWER 100 CONNECTION DATA
PTND%OR RNFTET OR
ISADAILD 2.00 STATION DEPTH C.
SPECIAL CONDITIONS ONLY 200tS MANHOLE REFERENCE
alUBBi LOWER
TYPE OF CONNECTION LENGTH FROM a
n
OWNERS PERMIT ; 1 00 CURB ML TO P L
AUTHORIZATION TOTAL FEE
t HAVE THIS DATE CONTRACTED WITH THE HEREIN NAKED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE WLIC SEWER
516NED THIS =DAY OF . �14�
� NEW HOUSE SEWER
OWNER OR -1 CONNECT ADDITIONAL
OWNERS AGENT [.[ _ .._ _ _ _ FEIE BUILDING OR WORK
rQ .� AND%OR DRAINFIELD PIT(S)
ADDRESS L7 7 .r
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS CESSPOOL I] DRYWELL E3
CATION AND STATE THAT THE ABOVE IS CORRECT AND
To COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
AND%OR LBCENSED IAS REQUIRED BY POS EANGELESS OOUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ABANDON HOUSE SEWER
�-� ER OF THE ABOVE
DESCRIBED
t RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS�
SIGNATURE M IVOI I IPIGFIA1rt OF SO �L SEEP PIT(S)E] CESSPOOLS bff
s'
OF PERMITTEE _ _
79A542A 663 7/55