HomeMy Public PortalAbout5801-5803-5805 TEMPLE CITY BLVD_Sewer__ DEPAiCTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINECR I BUILDING
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LOCALITY r
FOR APPLIe TO FI IN �* � -
ADORENGla AREST
ADORE OSS ST.
LOCALITY ` kt:
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DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST "", 15— r�A +9` o V S
CROSS ST.
RECEIVED BYE Ready for laepeetioa ,D+ATE ISSUED
OWNER r+.. CD ._. �/ .
MAILp„;:. ,""•`r" ;`• i
ADDRESS. . SE 20NE OCCUPANCY f BK PO
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CITY'.,:.,: +ice' T L.NO. C.. , �l
CONTRACTO '� ` ? +
CO.IMP.N0.
ADORE r JOB NO.
TEL.N y TRUNK PERMIT NO.
I"T❑ COUNTY ROAD PERMIT NO.
REGISTRATION N0. //
DESCRIPTION LOT NO. Lo f L} STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT �, 1 INDUSTRIAL
WASTE APPROVAL
SI2E OF LOT MO.OF BLDGS.
NOW ON LOT CHARGES
BU LDINGS r9oa. .,r,f CONNECTION CHARGE FEE *'
I DESIRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLfO SEWER ! i 8.50 t+ RECEIPT NO. I TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEP ON R CORDED
WORK TO HOUSE SEWER 1.00
ALE O REPAIR EXISTING NO- DA BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPT" l '
CESSPO RYW LL �,. ,
SPECIAL CONDITIONS ONLY 2.00 A/ MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT f I OO 'Y P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE �� "
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INBPECTOri SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER '?
SIGNED THIS__......_....._.DAY OF.._...__._._......•...._...._._19_.....
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...... _.._.._......—.__—. .___..—. ._. ._ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..............._..............---.._.._.._..—..............—.............. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[j DRYWELL
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 AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND
LICENSED AS REQUIRED BY LO8 ANGELES COUIITY
AND STATE OF CALIFORNIA OR THAT AM THE LEGAL.JOWN• ABANDON HOUSE SEWER
ER OF THE ABOVE D IBED RE ESTI PROP Ep}y BACKFILL SEPTIC TANKS��77
SEEP.PIT(S)[] CESSPOO90
SIGNATURE
OF PERMITTE idMil...
70A042A 005 7/58 =�