HomeMy Public PortalAbout4333 TEMPLE CITY BLVD_Sewer__ DEPAETMENT OF COUNTY ENGINIUM SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COIINTY OF LOS ANGELES
WILLIAM J FOX. COUNTY ENGINEER BUILDING
0 f CABBATT D GRIFFIN IN OF BuILDINU ADDRESS etof
FOR APPLICANT TO RLL IN /7 LOCALITY
BUILDING �� V.3 �2 � ` if ' /�'L/,.o; CEROSS BT
ADDRESS � �6 C
LOCALITY DISTRiorlro SERIAL NO PERMIT NO
NEAREST
ST. �osF.�'�./gtulAf A L5 � 3 S
R E e Ready far IngaeUaa DATE ISSUED
/n[ OWNER OtL 6oN �4 40 _
ADDRESS MAIL � �� /�.yyJ �.� /O USE Z E OCCUPANCY `�Q ✓ BK MAP PO
+L 'CITY^ /� TEL NO
/ CONTRACTOR /fj,��e ,,r -- ,P CHARGES REIMBURSEMENT FEE
ADDRESS �✓ Jf REQUIRED y
NOT REQUIRED
CITY evf5d Ir
TEL NO l / JOB NO CONNECTION CHARGE FEE
IV STATE />/ CO IMP NO
DESCRIPTION NO NTT RECEIPT NO I DATE By
LEGAL
DESCRIPTION LOT MO
BLOCK TRACT Z .^� (� .� WAIVER FOR RECORDING
SIZE OF LOT - NOW
BLOQ RECEIPT NO DATE BY
NOW ON LOT
USE OF
BUILDINGS
TRUNK PERMIT NO
NO DEBCRIPTIDN OF WORK FEE
'0OUSE SEWER CONNECTING TO ROAD PERM IT NO _-----T
PUBLICSEWER @ E SMI O
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 100 PERMIT NO
CON ECTADDITI NAL BLDG OR INDUSTRIAL DO E IC USE NLY
WORK TO HOUSE SEWER 1 00 WASTE APPROVAL Ing
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM ISO CONNECTION DATA
DI860 NNEjW D ABANDON SEWER _ �� '
AMDIN DISPOSAL SYSTEN 100 I STATION DEPTH
8EPT10 TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 240 I MANHOLE RiEE N�E LOWER
CESSPOOL Ci
SPECIAL CONDITIONS ONLY i 00 I _ TY F CORNECTIO P L LELN GTO PFROM
IL
OWNERS PERMIT t oo
AUTHORIZATION TOTAL FEE I HAVE THIS DATE 1111
CONTRACTOR TO CONNECT THE ABOVE CTED WITH RESCRIRED lXISTIMB APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER s.
SIGNED THIS T DAY O � y. .!. 19 kir. NEW HOUSE SEWER /� 2
OWNER OE / CONNECT ADDITIONAL
OWNERS AGENT 13UILDINGORRWORK
ADDRESS _ _ _ _ _ _ _
SEPTIC TANK,
GRAKMFIELD IT(8)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOLO DRYWELL[-]
TOTCOMPLYOWITH ALTHCTU
NTY ORDINANCESSAND STATE LAWS
REGULATING PLUM BI MB AND SEWERS ALTER REPAIR
SEWER
HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED SEWAGE DISPOSAL
SY STEM
AMD/OR LIOENBED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSESEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY RACKFILL SEPY16 TANKS FI
SIGNATURE SEEP PIT(S)[] CESSPOOLW[]
OF PERMITTEE _
76A6eSD M 11/08
I_
ID °
TBA S APPLICATION FOR PERMIT
A Ba4Z2O
COUNTY OR LOS ANGELES SEW R-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADO R..
COLEMAN W JENKINS SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL NCAncir
(PRINT OR TYPE ONLY) CROSS BT
LEGAL
O{T"I LOT NO OWNER -
MAIL
BL —TRACT ADDRESS
NO or eLDOt
HOW ON LOT CITY TEL No
USLl VBUOIDTRICT NO I GROUP uAaa MAP Roa eo BY
sN p0
CONTRACTOR
ADDRES67
CONNECTION DATA
CITY �p TEL NO STATION ` DEPTH O
LICENSE No LO 6-( CLASS 4C^� MANHOLE REFERENCE T J � uRr[R
NO DESCRIPTION OF WORK IEE Trp F o CTI OM LENGTH FROM
HOUSE SEWER CONNECTING TO Y IL ML TOPE
PUBLIC SEWER Ea DO
SERIC LANK SEEPAGE PIT OR �— P C MO
'ITB AND/OR DRA INFIELD O 310 GO CO IMP NO JOB NO
NOUS{SEWER CONNECTING TO TRUNK PERMIT NO �� ROAD PAURMIT NO y
P"TV AM DISPOSAL tYSTEM O $3 00 O
CONNECT ADO ITIOMAL OLDO OR AFFIDAVIT R4h• SAE,S.KT RECORD IMSTR NO DATE
WORK TO MOUSE SEWER O sa o0 V
OVERFLOWSC[PAOE PIT GRAINFIELD
L[TM CESSPOOL OMW[LL MANHOLE O [BOO HWy OR ST WID[NIN° O
ALTER REPAIR O •SA DO XOUS[
SM OR DISPOSAL SYS?M 41 U 04RAMMCON
[[NCROACHM[NT
IT NO f� y
STRIAL N
• E wPPROVAI Z_
OVVN. rS P RMT CHARGES
AUTHOMATION TOTAL PEE
CONNECTION CHARGE rc[
I HAVE AT THIS CATE A CONTRACT WITH THE HEREINBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED ETO THEPU 0LIC SEWERAMOVAU DATE INN[CTOR S SIGNATURE
SIGNED THIS DAY OP
0WHEN OR New HOUSE OMER
OWNERS AGENT
CONNECT ADDITIONAL
ADONESS BUILDING OR WORK
SCPTIC TANK BEET PIT(S)
I HEREBY THAT
THE ABO THAT I HAVE READ THIS AML ICATI OM ANO/OR GRAINFIELD
ANO STATE THAT TX[ ABOVE IE LAND S AND "" TO COMING
WITH ALL COUNTY OROMANCES AND STATE LAWS REGULATING ❑
pLUMSINO AND SEVERE CESSPOOL ❑ ORVW[LL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMO/OR ALTER REPAIR S[W[R OR
I.C[NSCO AS R[ D MY LOS ANOL[ O STATE OF SEWAO[DISPOSAL SYSTEM
CALF'ORN.A O XAT TMC L[O MLR 0• AM T[MD TO DISCONNECT PLUG AND
SIDE IN TH Ei1D[NT4L pR [RT ASANDONNOUS{SEWER
iIOr
AP{RMTTTVBACKFIN ICT KS [3n[EP (S) Li
VALMATI JACK R ALLEN
CK M D CR
ASH VISING MECHANICAL ENGINEER
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