HomeMy Public PortalAbout5537 TEMPLE CITY BLVD_Sewer__ DEPAILTADTT OF oOIIDITY EN(mHEEB I SEWER-SEWAGE DISPOSAL 7
DIVISION OF BU LDING AND SAFETY PERMIT APPLICATION 1
COUNTY OF LOS ANGIrF 1
WILLIAM J. FOX. COUNTY ENGINEER , BUILDING
ADDRESS
FOR APPLICANTJO FI 1 LOCALITY VNV
BUI LO NO
S3 NEAREST
ADDRESS CROSS ST
NLOCALITY EAREST DIBTRICT� A SERIAL NO PEplll NO s
ilk
ED Ready for Im"ll" DATEISSUED
OWNER
MAIL
ADDRESS USE ZONE j O1CCUPANCY� -1 YAP PO
CITY TEL NO — ' ` ...�/L�,�.L .� U 1"1BK ' /3
�50-
CONTRACTOR Yom_ __I �/�C'S IJ
CO.IMP NO Ac
ADDRESS
106 NO
CITY TEL NO QJll LSA TRUNK PERMIT NO
STATE h
REGISTRATION NO 2. COUNTY ROAD PERMIT NO 1 I?1 1
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK
TRACT/ (�Py._ d4AVj INDUSTRIAL , / _ / -/E S
MO OF SLOGS WASTEAPPROVAL cV
SIZE OF LOT NOW ON LOT CHARGES
IL
USE OF
BUILDINGS CONNECTION CHARS EE
ND DESCRIPTION OF WORK FEE
PHOUSE
BLIE 68EWVERCONNECTING TO F S W �O NEIMBURSEMENT FEE
RECEIPT NO TE V
HOUSE SEWER CONNECTING To
PRIVATE DISPOSAL SYSTEM 100
C YNECT ADDiTIONAL BLDG OR EXCEP RECORD D
WORK TO HOU WEB 100
AL ER-®RHI EXISTING Y DATE
SEWER OROISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR J //
PITS AND OR GRAINFIELD 4.00 STATION �(p Q DEPTH (O
CESSP00 ELL
SPECIAL CONDITIONS ONLY 400 / ` i MHPLE REFERENCE PER R
Y TYPE OF�IN�Y IOM LUL TORP LSM S
OWNERS PERMIT s 1 00 TCS
AUTHORIZATION TOTAL FEE J-0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOV DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PU LIC SEWER
SIGNED THIS L7 DAY OF _ 19-V NEW HOUSEGEWERj.-
OWNER OR CONNECT ADDITIONAL
OWNERS ADEN _ : BUILDINGORWORK
ADDRESS _�A.�� _ _ _ _ _ BNK SEP PIT
(S)
BEPIS)
AND/OR NK EP
ELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOLS DRYWELL�
CATION AND STATE THAT THE ABOVE IS OORREOT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS ° _SEWAGE DISPOSALSEWER OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED'
EM
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFON OR THAT A L L OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D REST BACKFILLS PTIC TANKSn
SIGNATURE SEEP PIT(S)[] CESSPOOLS11
OF PEOMITTEE _
Tou,"m 004 1/5E O
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