HomeMy Public PortalAbout5476 TEMPLE CITY BLVD_Sewer__ DEPA>irrDEENT OF COUNTY ENGININZ SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX. COUNTY ENGINEER ABU
DILDDINa `�/ 7� �T-
ADRE88 J / +rCll �y
FOR APPLICANT TO HLL IN n LOCALITY `,
ADDRESSEST
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LOCALITY dw DISTRICT MO SERIAL NO PERMIT NO
NEAREST r� A X996 75
CROSS 6T
RECEIV D RaableT lotO�allee DA 188U
OWNER 4 , 7zZ S
MAILPD
8 ��• USE ZO91 OCCUPANCY BK MAPADDRPO
CITY � • TEL■ —� I ��V' I 2 Z
CONTRACTOR 17r D (l 4. CO.IMP NO
ADDRESS /-
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CITY T[LNO.� Q� -2-7Q TRUNKPERMITNO
REGISTRATION NO STATE
ROAD PERMIT NO
DESCRIPTION LO N 0 !SO STATE ENCROACHMENT
PERMIT NO
BLOCK TRAM„ �� INDUSTRIAL
ASTE APPROVAL
SIZE OF LOT /r0 I z 7 MNOOW OPONLOTDG&
BL
� �2
USE
BUILDINGS CONNECTION CHARGE F
�9�
NO DF8CltiFTuoN OF WORK PE[ OFREIYBURSENENTFEE
NOUBE SEWER COMMEOTIM 0
PUBLICSEWER O $
860 RECEIPT NO TE BY
HOUSE SEWER CONNECTINS TO
PRIVATE DISPOSAL SYSTEM 100
C NNE ADDITIONAL BL OR EXCEPTION REC ED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 100
ISCONMECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGEPIT Oq
PITS AND/OR GRAINFIELD !AO STATION DEPTH
E"POOL-ORYWELL
SPECIAL CONDITIONS ONLY !00 / MAN P FERENCE GSI
PE OF COMNECTI LENGTH FROM
OWNERS PERMIT $ I oD wow olor, VL TOPL
AUTHORIZATION TOTAL FEE D
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DE RIBED EXISTINQ APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE ELIC BEV �-
SIGNED THI AY O 19 NEW HOUSE SEWER - t
OWNER OR CONNECT ADDITIONAL
OWNERS AGE RT _ / BUILDING OR WORK
SEPTIOTAMK SEEP PITH
ADORESS+E'L AND/OR GRAINFIELD
CATIONNAMU STATE WHAT THE ABOVE 8 CORRECT AND AGREE OE88POOL Q DRYW[LL
TO COMPLY WITH ALL COUNTY ORDINANCE8 AND STATE LAWS ALTER REPAI SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOD E SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSESEWER
ER OF THE ABOV,�,E DESORIB[D RESIDENTIAL PRO.P.EERTY,po RACKPIL
SEEP PI LSEPTIt)E) CE88POA G -
SIGNATUREOF PERMITTEE L L _ �3YSY
76A0/3A 60 7/68 ��