HomeMy Public PortalAbout5516 TEMPLE CITY BLVD_Sewer__ DEPAUTMENT•)r OOUNTY ENGDn= ' SEWER—SEWAGE DISPOSAL 1
DMsION OF BUILDING AND SAFETY ' PERMIT APPLICATION
OOi}NTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, Cou NTY ENo1NEER I ADOREB8 f
FOR PLI �C NT TO N LOCALITY '
BUILDING �� NEAREST
ADDRE8 / / / CROSS 8T Q
LOCALITY ��/ DIRTYING SERIAL NO gPERMIT NO}
NEAREST _ A / a�� c"� ��� �J
CROSS IV Ready for larpaatlan DATE ISSUED
OWNER f-/0
-15_54-
MAIL - CJ, USE ZONE OCCUPANCY MAP
ADDRESS T�� L�
PG
CITY 7, TEL NO
CONTRACTOR CO IMP MO
ADORE TEL NO JOB MO
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CITY Ej TRUNK PERMIT NO
REGISTRATION NO O COUNTY ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACTL v INDUSTRIAL
APPROVAL
812E OF LOT SS SNOW ON LOTS GHA _
USE OF �..(
BUILDINGS p� ,Y' /1 1 CONNECTION CHARGE FEE
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICBEWER a i 280 RECEIPT NO DAT BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG ON EXCEPTION RECO OED
WORK TO HOUSE SEWER 100
ALTER Oil REPA R EXI NO GATE BY
SEWER OR DISPOSAL SYSTEM 100
DNSOSYMM SEWER
AN SYSTEM 1 M CONNECTION DATA
FP N •SEEPAGE PIT OR
ITS ANO OR GRAINFIELD 200 STATION DEPTH
E PO L-°RYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT = I 00 Y CURB v L ML TOP L
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH E MAI■ NAM[0
CONTRACTOR TO CONNECT THE ABOVE/
BOV SCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO P B,LDICC4ISEWER
SIGNED THI OF Iq— NEW HOUSE SEWER
OWNER OR n./9�•`a',yQ/�- CONNECT ADDITIONAL
OWNERS AGENT_ �.y ��/�'0' BUILDING OR WORK
__ _�d✓_C _ IIS�o'� SEPTIC TANK,SEEP PIT(8)
ADDRESS--- AND/OR DNA MFI P
LD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] ORYWELL 0
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 DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LO NGELES COUNTY
AND STATE OF CALIFOR OR THAT NE EGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE ° ALPP -P ILLSEPTIC TANK
� II�'TI
SIGNATURE SEEP PIT(8) CESSPOOLS
OF PERMITTEE,
76AOI2A .d2 7/52 Parr,., 14"A/