HomeMy Public PortalAbout4450 TEMPLE CITY BLVD_Sewer__ DEPAR� OF COUNTY ENOINEISB SEWER-SEWAGE DISPOSAL _1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANOELEA
' WILLIAM J FOX, COUNTY ENGINEER BUILDING D /!
CASGATD GRIFFIN LO
SUPT of BUIINU ADDRESS
'T C.
FOR APPLICANT TO H L IN LOwu'n A Ad
BUILDING ,///�O A f �/ '_ _ �y} ®" CR08S NEARESTT f/
ADDRESS 77 ,V CFf>:4LNT ��/��,�
LOCALITY DISTRICT NO SERIXL NO PERMIT NO
NEAREST J7 A 17D 8a S
CROSS ST
RE6 VE6WY Ruftfar lErPwUw DAT6188UFD
OWNER /// -/7 -s
PAIL USE SON/E•7 OCCUPANCY BK MAP PO
ADDRESS r
��pl e$
CITY EL NO
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADORE REIRED .
MOTQUREQUI �)
RED
CITY TEL M
JOB MO CONNECTION CHARGE FEE
STATE
REGISTRATION
REGISTRATION NO{,,.v 94kGO IMP NO 1
LEGAL /[ RECEIPT NO DATE BY
DESCRIPTION LOT NO T
BLOCK TRACT 42=9 WAIVER FOR RECORDING
SIZE OF LOT �T NO OF BLDGS RECEIPT NO DATE BY
�OXI ! NOW OM LOT
USE DI � /J .�i1 1
BUILOIM08 �/4,�(
NO DE CRIPTION OF WORK FEE TRUNK PERMIT NO
XO E SEWER NNECTINB TO ROAD PEgM1T MO ••^_�-
PUBLIC SEWER @ S 860 a
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE D18POSALSYSTEM IDD PERMIT NO
CONNECT ADDITIONAL BLDG OR I INDUSTRIAL
WORK TO HOUSE SEWER I DO WASTE APPROVAL '^�__�
ALTER OR RE PAIfl EXISTI NO
SEWER OR DISPOSAL SYSTEM 100 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM IGO STATION DEPTH f
SEPTIC TANK,SEEPAGE PIT OR
PITS AND OR DRAI NFIELD 2DO MANNOL E R i
OEBBPOOL-Dfl WELL UPPER
SPECIAL CONDITIONS ONLY 200 TYPE OF CONNECTION COP LENGTH FROM
CURB 'TL- M L TO P L
OWNERS PERMIT f 1 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH,THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE tlESCRI BED EXISTING APPROVALS INSP6TOR'8'SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER ��zz�� _
SIGNED THIS_ DAY OF Igf..,( MEW XOUSk SEWER �� A OWNER OR s- CONNECT ADDITIONAL
OWNERS AR BUILDING OR WORK
ADDRESS - SEPTIC AND/OR DRAT NFSEEP LD
IT(8)
I HEREBY ACKNOWLEDGE AT I HA6 READ THIS APPLI CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
=PERMITTEt5a'ol%�.e
ENSEDEREBY IAS REQLgRED BY PLOS EANGELES ICOOUNTY
DISCONNECT PLUS AND
OF CALIFORNIA OR THAT 1 AY THE LEGAL OWN- ABANDON HOUSE SEWER
ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANK
E-�wCi%'EC�'�1 SEEP PIT(B)� CEBBPOOL�E 4/52IV -