HomeMy Public PortalAbout5732-5734 TEMPLE CITY BLVD_Sewer__ DEPARTMENT OF COUNW ENGEVEER SEWER.-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COU= OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS � I �� �.•I<-'�-r+1(.�' � +• �`:.!';(�
FOR APPLICAjff TO FILL IN LOCALIT?
BUILDING ' . NEAREST
ADDRESS �i .7 ��'/YJ/�iC� �i T d CROSS 8T. C,
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. C
NEARESTJ�s .���� s -5-- _ A
CROSS ST. !V (� / p R C IVED BY Ready for Inspection DATE ISSUED
OWNER 4MAIL tic ma�0&2
ADDRESSdi , r USE ZON OCCUPANCY BK MAP PS
CITY ,S TEL.NO ,7-C,14g6 --F;I—3 I :7 •E
CONTRACTOR4. .p 1-4 911w, Cc,CA6'p � CO.IMP.N0.
ADDRESS _7�gB es JOB.NO.
CITY h0„g41VR4p TEL.NO,4j-y_A71f TRUNK PERMIT NO.
STATE
REGISTRATION NO. Z&O ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO. d( �j(@�C=��/k2�! STATE ENCROACHMENT !^
PERMIT N0.
BLOCK TRACT ��/ INDUSTRIAL
10.OF BLDOS. WASTE APPROVAL
SIZE OF LOT 'Q
49,1o'*
S NOW ON LOT CHARGES
USE OF
BUILDINGS G9 CONNECTI LARGE FEE.
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE���,l
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.00 RECEIPT N0. WATE'- 113Y
HOUSE SEWER CONNECTING TO `
PRIVATEDISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR �� EXCEPTION RECORDED --,_
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONAND/ORNDISPOSAL ECT AND YSTEM SEWER 1.00 /�� CONNECTION DATA `l
PITS ASEPTIND/OR .DRAI FIE DOR IT 2.00 STATION (-;-.-� Cl DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
I OWER
TYPE OW- LNECT.!N LENGTH FROM _I
OWNERS PERMIT ¢ 1 00 "i P.L.J M.L.TO P.L. l a
AUTHORIZATION TOTAL FEE 1 �Q
IED
THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABBY DESCRI D EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THEPUBL 8EW
SIGNED THIS.. __ NEW HOUSE SEWER SG�yap -14^ t
OWNER OR CONNECT ADDITIONAL
OWNERS BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
r
1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLI. CESSPOOL❑ DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING A D SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY .' I A OPER EGISTERED ISCONNECT PLUG AND
AND/OR LICENSED A IRE L GE ES COUNT NOON HOUSE SEWER
ER OF THE ABO L D IS I �P L 6A 0 KFILL SEPTIC TANKS E]
SIGNATSEEP.PIT(S)[:] CESSPOOLS�
URE E
OF PERMITTE . ....... - - -. .. ._...... .._. .........
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