HomeMy Public PortalAbout5471 TEMPLE CITY BLVD_Sewer__ DF.PARTSffiVT OF COUNTY ENGINI R SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, CouHrr ENDINEER BUILDING L1
ADO RE88
FOR APPUCANT�T-O FILL/IN/✓ /LOCALITY
BUILDINGADDRESS S 7� Tiw /� (�C/' CROSS BT P LA
LOCALITY � �� �� DISTRICT NO SERIAL NO PERMIT NO C
NEAREST
CROSS ST
R CEIVED BY Ready fw IntoWlan `DATE ISSUED
OWNER Nc� (--(<�-C �/l�l 01� _ ✓—�Z.'J
MAIL
ADDRESS USE 20 OCCUPANCY SK MAP PG
S 8/j/N ��
CITY TELMO. — -
CONTRACTOR b'�C_(D p. 't ,BOATIZ� Z
eo.IrP No
ADDRESS ZSZ3 32 A-5?1 Sf JOB.NO
CITY�O n p p�� pTEL NO 7'Q - s 9 ��1 TRUNK PERMIT NO (
RE LEGAL
ROAD PERMIT NO TION NO 92.7 7 6 C.. CDUNTYI Z 3 V
STATE
LEGAL
DESCRIPTION LOT MD STATE ENCROACHMENTPERMIT NO
BLOCK TRACT 8 ZO INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO Q x I ILD
NOW ON LOT0. CHARGES
USE OF
BUILDIMGB� u lq CONNECTION C E FEE
NO DESCRIPTION OF W RK FEE REIMBURSEMENT FEE
HO SE SEWER NNEOTIM O
PU BLICSEWER C i 8.60 3 RECEIPT NO DA BY
HOUSE SEWER CONNECTINO TO
PRIVATE DISPOSAL SYSTEM 160
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 MO DATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100 _
DISCONNECT AND ABANDON SEWER
AND OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OB
PITS AND OR GRAINFIELD 240 STATION - DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 1 l� D M IDPLE F E R E N C E
PEWC LENOTH FROM �I
OWNERS PERMIT : DD rM L TOP L
AUTHORIZATION TOTAL FEE S�
1 HAVE THIS DATE CONTRACTED WITH TN HEREIN NAMEG
CONTRACTOR TO CON EC THE ABOVE SIByp EXI APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO E PUBLIC SEWER U
NEW HOUSE SEWER
516N1 AY — s CA,moo G
OWNER BUILDING
/ADDITIONAL
E _— BUILDING Oq WORK
OWM
BEPTIO TANKK,,BEEP.PIT(S)
ADDRESS ANO/OR DRAIMFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE OISPO EWEROR
I HEREBY CERTIFY T 1 AN PROPERLY GISTERED
L SYSTEM
AND/OR LICENSED A JWQUIRED BY LOB AN S COUNTY DISCONNECT PLUG AND
AND STATE OF CALI MIA 0 THAT LOS
GAL OWN. ABANDON HOUSE SEWER
ER OF THE ABDVW_%ESCSIB RESIDENTIAL PERTY TANKSI�
SIGNATURE BEEP PIT(S)� CESSPOOLFO . 'ff_42_
III OF PERMITTEE _ 1
76A842A 603 7/63