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HomeMy Public PortalAbout5742-5744 TEMPLE CITY BLVD_Sewer__ - DEPAliTNIE_NT-OF COUNTY ENGINE= _!�:: SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY 'PERMIT APPLICATION COUNTY OF LOS ANGELESBUILDING (� WILLIAM JF.M.Fr COUNTY ENGINEER I ADDRESS , `� { �- '� TfaYII!�1i2 C� ��j � Lo.cL�FORAPPLICANTO -IN �TT:C.,� FI LIj� / � 'NEAREST 0� .ADDRESS RSS'ST. C7 Lam` Zl�. -'LOCALITY j DISTRICT NO." SERIAL NO. PERMIT NO. NEAREST. 0 e w ! _ `O 1 s CROSS ST. /7 ;i I,R�ECEIVED BY Ready for Inspection -DATE ISSUED OWNER L `: MAIL ryry USEZOW OCCUPANCY MAP ADDRESS Z.70 PA 4. � �j4'! BK PG CITY /7 , Ca DI TEL.NO.�Q^��'1 J y — 3_ I.. . ,t CONTRACTOR L.% ,� CO.IMP.NO. �`30�y - ADDRESS F360 L:, a,/. f f�-9, A AW, JOB NO. ^ CITY os C . r4,4D TEL.NO. -,z-X7/ j TRUNK.PERMIT,NO: REGISTRATION NO. STATE ROAD PERMIT'NO. . r_)l G9q 0,�j LEGAL ® i STATE EINCROACHMENT�—+ DESCRIPTION LOT N0. % PERMIT'NO. BLOCK' TRACT , INDUSTRIALS WASTE APPROVAL SIZE OF'LOT ! I NO..OF BLOBS. X Q, NOW ON LOT CHARGES BUILDINGS ;i CONNECTION C Ry FEE NO., DESC IFTI.ON OF WOR FEE - HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE -_ PUBLICSEWER $ 3.50 Q� RECEIPT NO. AT BY HOUSE SEWER CONNECTING TO _ - :-'PRIVATE DISPOSAL SYSTEM 1.00 `I CONNECT ADDITIONAL'BLDG.ORtl EXCEPTION RECORDED ;WORICTO.HOUSE SEWER 1.00 = ALTER OR REPAIR EXISTING NO- I DATE I BY SEWER OR DISPOSAL SYSTEM 1.00 ! 'DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM, 1.00 - I CONNECTION DATA. SEPTIC TANK,SEEPAGE.PIT OR -• - 6. PI.T.S AND/OR DRAINFIELD 2.00 STATION .�-� ��+�•.ti, DEPTH -�---r CESSPOOL—D RYW ELL .4 SPECIAL-CONDITIONS ONLY_ 2.00 61 N#f EFERENCE ITPPER` Jciq TYPE CTIO& LENGTH FROM. M.L.TO P.L. OWNERS PERMIT $ .1 00' AUTHORIZATION. - "TgrAL FEE-- 4.50 1 HAVE.•THIS-DATE.-CONTRACTED WITH .THE HEREIN NAMEDi' S' CONTRACTOR TO CON ECT THE ABOV .DESC BED EXISTING 1. APPROVALS INSPECTOR'S SIGNATURE. DATE DWELLING TO T E BL SEW P // SIGNED_THNEW HOUSE SEWER OWNER. - OR !' CONNECT ADDITIONAL- OWNERS A NT BUILDING OR WORKSEPTIC TANKSEEP. _ _ ...... 4 AND/OR DRAINF ELI)IT(8)I - 1 HEREBY ACKNOWLEDGE.THAT` HAVE READ"THIS.APPLI-l' CESSPOOL DRYWELL CATION AND STATE THAT THE ABOVE I8.CORRECT:AND AGREE'; TO COMPLY WITH ALL C. NTY:ORDINANCES AND=STATE LAWS" ALTER;REPAIR,SEWER OR. REGULATING PLUMBIN ND SEWERS: SEWAGE DISPOSAL SYSTEM " I. HEREBY CERTIF T 1 AM PROP WE -EGAJ;,OWN. - REGISTERED" AND/OR LICENSED' U1R AELES COUNTY:! .DISCONNECT PLUG AND AND STATE OF CA F IA 0 T ABANDON HOUSE SEWER ER.OF—THE—ABO! RI 81 P P BACKFILL SEPTIC TANKS SIGNATURE SEEP.PIT(S)r CESSPOOLS-0 . OF PERMITTE -- _ -76A642A. 663 -7/53