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HomeMy Public PortalAbout5411 TEMPLE CITY BLVD_Sewer__ DEYAUTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUUMING AND SAFETY PERMIT APPLICATION • COUNTY OF LOS ANOELES WILLIAM J. FOX, COUNTY ADDRE ENGINEER BUILDI SS NB ++ / • FOR APPLICANT TO RLL IN LOCALITY `p A DDS S J'G/y SCE NEAREST CRO ST MAIL OCALITY M) �^ DISTRICT NO SERIAL NO hhPEfl?11T NO NEAREST Gh Ir Y A - V J � / S • „ I RECEIVED BY Gas&Iw 10g0wd" DATE 1 ED WNER f 4 �7� 1 ��,(/1 I p UGH ZOM[ OC PA CY AP B PO CITY I�J, DANTE TEL116 Fp god` 3' CONTRACTOR ��-N �JZJ��� CO•IYP NO �• — ADDRESS ^ _ JOB NO CITY I� ZhTE MOS TRUNK PERMIT MO �— BTATE REGISTRATION M ROAD PERMIT NO 3 ' LEGAL DESCRIPTION LOT NO STATE ENCROACHMENT PERMIT NO BLOCK TRACT INDUSTRIAL MOOW BLDG6 ^q q WASTE APPROVAL SIZE OF LOT MOW F LOT ✓�' CHARGES USE OF BUILDINGS ReA/ CONNECTION CHARGE FE[` MO DESCRIPTION OF WORK EE HOUSE SEWER CONNECTING TO [ALTER RSEMENT FEE PUBLIC SEWER O 0 800 CEIPT NO DATE BY HOUSE—SEVER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 CONNECT ADDITIONAL BLDG R EXCEPTION RECORDED WORK TO HOUSE SEWER 100 ALTER ER REPAIREXI8TING NO BATE BY SEWER OR DISPOSAL SYSTEM 100 DISCONNECTAN ABANDON BEWEp AMD OR DISPOSAL SYSTEM 100 CONNECTION DATA SEPTIC TA PAG PIT OR / PITS ANO/OR GRAINFIELD 200 N DEPTH -cmPOOL—DRYWELL SPECIAL CONDITIONS ONLY 200 1p^ MANHOLE REFERENC O 4IAPER7 LOWER E OF CONNECTION LENGTH F N OWNERS PERMIT $ I 00 �R —tom M L TO P L AUTHORIZATION TOTAL FEE �^ 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING , PROVALS INSPECTOR'88 NATURE GATE DWELLING TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ OUSE SEWER OWNERS OR _ _ _ _ _ ___ MO ADDITIONAL ADDRESS _ TANK SEEP PIT(S) R DRA{NFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- OL E] DRYWELL❑ CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSREPAIR SEWER OR REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY DISCONNECT PLUG AND AMD BTATH OFC RNIA OR THAA,T 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOV D CRIB EBIDEMTIA PIIOPERTY KFILLB TANK 818 MATURE BEEP PIT(8I� CESSPOOLS E] OF PERMITTEE _ 70A642D 001 1/68