HomeMy Public PortalAbout5339 TEMPLE CITY BLVD_Sewer__ DF.PARTBIENT OF OOIINTY ENOINFd7t SEWER-SEWAGE DISPOSAL 1
DIVISION OF-BUMDING AND SAFETY PERMIT APPLICATION
OOUTI OF LOS ANGELES
WILLIAM J. FOX, COUNT' ENGINEER BUILDING �2
ADDRESS
FOR APPLICANT TO RLL IN �(
LOCALITY
ADDRESSBUILDING �j �1 p yNs(3 \ p/ CROSSST 0
LOCALITY __ DISTRICTNO SERIAL NO PERMIT NO
NEAREST A 0 S
CROSS 8T
RECEIVED BY Ready-f"lelpMbe GATE ISSUED
OWNER aT�,Ou- �I�T--•iy , :S
MAIL
ADDRESS U E 20Nfi y� OCCUPANCY BK MAP/M
CITY L"� T[LMO. L ►I i/` G I k /'� /
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CONTRACTOR N�Y-1 (suda Jrr n OD.IMP.No O
ADDRESS 7 11 �I
JOB.NO
CITY /. / TEL.!O cj TRUNK PERMIT NO
REGISTRATION NO STATE
ROAD PERMIT NO
Of8CR1 L T N0� J � ATE ENCROACHMENT
� " PERMIT NO
BLOCK TBACT %S /pw Gr INDUSTRIALWASTE
SIZE OF LOT S'V1(, /.S NO OP B
MOW OM LOTLOT
CHARGES
USE OF
BUILDINGS CONNECTIOI ! OE FEE
NO DESCRIFITION OF WORK FEE REIMBURSEMENT FEE '
USE SEWER MIECTII
PUBLIC SEWER Los RECEIPT NO DA BY
XOUBE E ER OOpN[CTIN O '
PRIVATE DISPOSAL SYSTEM ISO
CONNECT A L BLD EXCEPTION RECORDED
WORK TO HOUSE SEWER 100
ALTER ON#rPAIR[XISTI G NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
bigrONNtOT AND ABANDON SEWER
AND/O R DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK.SEEPAGE PITO -
PIT$AND OR GRAINFIELD 2400 STATION - D[PTX
88Po L—DBTW[LL
SPECIAL CONDITIONS ONLY LOS A EFERENCE
P
TYPE OF CONNE t�ENOTH FROM • /
Y CURB PL N L TO P L
OWNERS PERMIT ; 1 00
AIJTHO�ItATION TOTAL RE
1 HAVE THIS DATE CONTRACTED WITH THE XER[IN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTbIA SIGNATURE DAT
DWELLING TO THEELIC SEWER
SIGNED THIS- P pAy P, lot NEW HOUSE SEWER a� �
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
BEPFIC TANK.SEEP.PIT(B)
ADDREBB__ AND OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HfIVE READ THIS APPLI- CESSPOOL[3 ORYW[LL�
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STAT[LAWS ALTER pE►AIR SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE
DI
L SYSTEMOR
1 HEREBY CERTIFY THAT 1 AN PROII R[ ER[D
AYD/Oq LICENSED AB UIRED Y MM- -
BA"2A
AB�AMDOM HOUSE SEWER
LSEG
ND STATE OF PAL M O T TH
R OF T oY EB IB _ Bt C L
IGNATUBEEP PIT(8) CEBSPoOL3 3PERNITT
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