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HomeMy Public PortalAbout5335 TEMPLE CITY BLVD_Sewer__ As�NT OF COUNTY ENGM= SEWER—SEWAGE DISPOSAL 1 - -� iOx OF sUELDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANOlff WILLIAM J. FOX, CIJJINTY ENGINEER BUILDING CASSATT D GRIFFIN SUPT Or BYILOINO A00REBR FOR APPLICANT TO RLL INUEA BUILDING 1 ADORE88 LOCALITY • SERIAL NO PERMIT NO NEAREST f A SQL S Ready fN•IaWaetlao DATEISSUED OWNER 1 :�.—/ NAIL j ADDRESS J USE ZONE OCCUPANCY BK N�PB CITY /J� TEL NO / CONTRACTOR I CHARGES REIMBURSEMENT FEE ADDRESS A �asy_4 REQUIRED Fi NOT REQUIRED CITY TEL NO JOB NO CONNECTION CHARGE FEE STATE REGISTRATION NO COUNTY 00 IMP NO LEGAL RECEIPT NO DATE BY DESCRIPTION LOT NO BLOCK TRACT %!L4a��QG . WAIVER FOR RECORDING r y0 OF 13LDGS SIZE OF LOT S .� G /1'SNOW ON LOT RECEIPT NO DATE BY USE OF BUILDINGS NO DESCRIPTION OF WORK FEE TRUNK PERMIT NO HOUSE SEWER CONNECTING TO B S $MI ROAD PERMIT NO PUBLIOEWEI HOUSE SEWER CONNECTING TO STATE ENCROACHMENT PRIVATE DISPOSALSYSTEM 1.00 C O a PERMIT NO CONNECT ADDITIONAL BLDG OR INDUSTRIAL WORK TO HOUSE SEWER 100 WASTE APPROVAL ALTER OR REPAIR E 9 1 TIM SEWER OR DISPOSAL SYSTEM 100 CONNECTION DATA DISCONNECT AND ABANDON SEWER AMD/OR DISPOSAL SYSTEM 100 STATION DEPTH SEPTIC TANK,SEEPAGE R PITSANOOR GRAINFIELD 2.00 MANHOLE REFERENCE CESSP 0 RYWELLt O Q UPPER LOWER SPECIAL CONDITIONS ONLY 700 ✓ TYPE OF CONNECTION LENGTH FROM Y CURB P L -ML TOP L OWNERS PERMIT f 1 00 AUTHORIZATION I TOTAL FEE 4Orb 1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS DAY OF _ _ _ _ 19 _ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT _ _ _ _ _ _ _ __ _ _ __ _ BUILDINOORWORK ADDRESS _ _ _ _ - - - - AID/OR GRAINFIELD PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLI CESSPOOL I] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I THAT I AN AMD/ORREBY FY LICENSED IAB REQUIRED BY PROPERLYLOS ANGE ESSISTERED COUNTY DISCONNECT PLUG AMD AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ABANDON HOUSE SEWER ER OF THE A80VE 0 SCRIBED RESIDENTIAL PROPERTY BAC F LL EPTIC TANKS II""'TI SIGNATURE SEEP PIT(S)[] CESSPOOLS / OF PERMITTE _ 76A"2D 60 13/65