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